Shorter duration of oral N -Acetylcysteine therapy for acute acetaminophen overdose

Woo, Olga F.; Mueller, Paula D.; Olson, Kent R.; Anderson, Ilene B.; Kim, Susan Y.

doi:10.1016/s0196-0644(00)70055-2

Cited by 92 publications

(49 citation statements)

References 18 publications

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“…The traditional treatment protocol for APAP poisoning in the USA consists of a 72-h course of oral N-acetylcysteine (NAC) [2][3][4]. More recently experts have recommended patient-tailored approaches to oral NAC treatment [5][6][7][8][9][10][11][12]. These protocols seek to truncate NAC therapy for patients showing evidence of recovery.…”

Section: Introductionmentioning

confidence: 99%

The Clinical Management of Acetaminophen Poisoning in a Community Hospital System: Factors Associated with Hospital Length of Stay

Offerman

2010

J. Med. Toxicol.

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Acetaminophen (APAP) overdose is the most common pharmaceutical poisoning. The objective of this study was to examine the management of patients admitted for treatment of APAP overdose. Factors impacting hospital length of stay (LOS) were of particular interest. This was a retrospective cohort study of patients admitted to Kaiser Permanente Northern California hospitals for APAP overdose from July 2003 through December 2007. Medical records were abstracted for patient demographic data, key factors of overdose, California Poison Control System (CPCS) contact, data regarding hospital course, transfer for liver transplantation, and death. Four hundred thirty-five patients were included. The mean hospital LOS was 66.5 h (95% CI 62.1, 71.0). Four patients (0.9%) died. Eight patients (1.8%) were transferred for liver transplantation, but all of these patients later recovered without transplant. Of 289 cases eligible for placement on the RumackMatthew nomogram (acute ingestion with known time of ingestion <24 h and normal liver enzymes), 161 (55.7%) had APAP levels above the "200" line and 77 (26.6%) fell below the "150" line. CPCS was contacted in 295 cases (67.8%). Mean LOS in cases with CPCS consultation was 61.9 h (95% CI 57.2, 66.5 h) versus 76.3 h (95% CI 66.6, 86.0 h) in those without. LOS in cases treated with IV NAC was 67.1 h (95% CI 57.7, 76.5 h) versus 66.4 h (95% CI 61.2, 71.5 h) in cases treated with oral NAC. Many patients admitted for APAP overdose had serum APAP levels below the minimum toxicity level. Use of IV NAC did not impact hospital LOS. CPCS consultation appeared to decrease mean hospital LOS.

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Section: Introductionmentioning

confidence: 99%

The Clinical Management of Acetaminophen Poisoning in a Community Hospital System: Factors Associated with Hospital Length of Stay

Offerman

2010

J. Med. Toxicol.

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“…8 It has been shown that the 20-hour and 48-hour IV NAC regimens and a 24-hour oral course are at least as effective as the standard 72-hour oral regimen in those who have not developed toxicity by the time the course has finished. 9,10 Therefore, it has become standard practice at our regional poison treatment center and others to discontinue treatment after one day if acetaminophen is undetected and aminotransferase levels are normal.…”

mentioning

confidence: 99%

“…10 Because the end of a 20-24-hour course will naturally be well past 24 hours postingestion, it is not surprising that discontinuation then, if the aminotransferase is normal, is effective. 9 In late presenters and for those with hepatic injury, short-course NAC is less effective. 1,10 This is likely due to a loss of the benefits of late NAC administration and discontinuation of NAC in the presence of progressing injury.…”

mentioning

confidence: 99%

Medical Fortune‐telling: Predicting Acetaminophen Toxicity

Donovan

1999

Academic Emergency Medicine

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“…The FDA approved a 72-h oral NAC regimen in 1985. However, evidence supports using shorter oral NAC courses provided that liver enzymes and synthetic function are normal or improving, and plasma APAP concentration is undetectable [1,2]. I n t r a v e n o u s N A C ( A c e t a d o t e ® , C u m b e r l a n d Pharmaceuticals) was approved by the FDA in 2004 and is indicated to prevent or lessen hepatic injury after potentially toxic APAP ingestion.…”

Section: Disclaimermentioning

confidence: 99%

ACMT Position Statement: Duration of Intravenous Acetylcysteine Therapy Following Acetaminophen Overdose

2016

J. Med. Toxicol.

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Shorter duration of oral N -Acetylcysteine therapy for acute acetaminophen overdose

Cited by 92 publications

References 18 publications

The Clinical Management of Acetaminophen Poisoning in a Community Hospital System: Factors Associated with Hospital Length of Stay

The Clinical Management of Acetaminophen Poisoning in a Community Hospital System: Factors Associated with Hospital Length of Stay

Medical Fortune‐telling: Predicting Acetaminophen Toxicity

ACMT Position Statement: Duration of Intravenous Acetylcysteine Therapy Following Acetaminophen Overdose

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