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====IV==== | ====PO==== <!--T:1--> | ||
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*Less preferred than IV route due to unpleasant taste and smell | |||
*140 mg/kg PO load | |||
*70 mg/kg PO q4hr x17 doses additional; dilute to 5% soln | |||
====IV==== <!--T:3--> | |||
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*Loading dose: 150mg/kg in 100 mL D5W over 60min | *Loading dose: 150mg/kg in 100 mL D5W over 60min | ||
*Second (maintenance) dose: 50mg/kg in 250 mL D5W over 4hr | *Second (maintenance) dose: 50mg/kg in 250 mL D5W over 4hr | ||
*Third dose: 100mg/kg in 500 mL D5W over 16hr | *Third dose: 100mg/kg in 500 mL D5W over 16hr | ||
====Comments==== | |||
====Comments==== <!--T:5--> | |||
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*Almost 100% effective if given <8 hr post-ingestion; less effective if 16-24 hr post-ingestion | *Almost 100% effective if given <8 hr post-ingestion; less effective if 16-24 hr post-ingestion | ||
*May still be useful >24 hr post-ingestion, even with fulminant hepatic failure. Give NAC until LFTs improve (not until APAP level is 0) <ref>Keays R, Harrison PM, Wendon JA, et al. Intravenous acetylcysteine in paracetamol-induced fulminant hepatic failure: a prospective controlled trial. BMJ. 1991;303(6809):1026-1029. (Prospective randomized controlled trial; 50 patients)</ref> <ref>Harrison PM, Keays R, Bray GP, et al. Improved outcome of paracetamol-induced fulminant hepatic failure by late administration of N-acetylcysteine. Lancet. 1990;335(8705):1572- 1573. (Retrospective analysis; 100 patients)</ref> | *May still be useful >24 hr post-ingestion, even with fulminant hepatic failure. Give NAC until LFTs improve (not until APAP level is 0) <ref>Keays R, Harrison PM, Wendon JA, et al. Intravenous acetylcysteine in paracetamol-induced fulminant hepatic failure: a prospective controlled trial. BMJ. 1991;303(6809):1026-1029. (Prospective randomized controlled trial; 50 patients)</ref> <ref>Harrison PM, Keays R, Bray GP, et al. Improved outcome of paracetamol-induced fulminant hepatic failure by late administration of N-acetylcysteine. Lancet. 1990;335(8705):1572- 1573. (Retrospective analysis; 100 patients)</ref> | ||
*Be aware NAC treatment may affect PT. May see a dose-dependent increase in PT following NAC in patients without hepatotoxicity. <ref>Wasserman GS, Garg U. Intravenous administration of Nacetylcysteine: interference with coagulopathy testing. Ann Emerg Med. 2004;44(5):546-547. (Letter)</ref> | *Be aware NAC treatment may affect PT. May see a dose-dependent increase in PT following NAC in patients without hepatotoxicity. <ref>Wasserman GS, Garg U. Intravenous administration of Nacetylcysteine: interference with coagulopathy testing. Ann Emerg Med. 2004;44(5):546-547. (Letter)</ref> | ||
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Revisión actual - 07:35 20 ene 2026
PO
- Less preferred than IV route due to unpleasant taste and smell
- 140 mg/kg PO load
- 70 mg/kg PO q4hr x17 doses additional; dilute to 5% soln
IV
- Loading dose: 150mg/kg in 100 mL D5W over 60min
- Second (maintenance) dose: 50mg/kg in 250 mL D5W over 4hr
- Third dose: 100mg/kg in 500 mL D5W over 16hr
Comments
- Almost 100% effective if given <8 hr post-ingestion; less effective if 16-24 hr post-ingestion
- May still be useful >24 hr post-ingestion, even with fulminant hepatic failure. Give NAC until LFTs improve (not until APAP level is 0) [1] [2]
- Be aware NAC treatment may affect PT. May see a dose-dependent increase in PT following NAC in patients without hepatotoxicity. [3]
- ↑ Keays R, Harrison PM, Wendon JA, et al. Intravenous acetylcysteine in paracetamol-induced fulminant hepatic failure: a prospective controlled trial. BMJ. 1991;303(6809):1026-1029. (Prospective randomized controlled trial; 50 patients)
- ↑ Harrison PM, Keays R, Bray GP, et al. Improved outcome of paracetamol-induced fulminant hepatic failure by late administration of N-acetylcysteine. Lancet. 1990;335(8705):1572- 1573. (Retrospective analysis; 100 patients)
- ↑ Wasserman GS, Garg U. Intravenous administration of Nacetylcysteine: interference with coagulopathy testing. Ann Emerg Med. 2004;44(5):546-547. (Letter)