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N-Acetylcysteine

N-acetylcysteine (NAC) is the most widely used sulfhydryl donor in the treatment of paracetamol poisoning. Standard therapy consists of a series of three infusions given over 20 hours. It is almost completely protective against paracetamol-induced hepatotoxicity when administered within 8 hours of an overdose. Adverse effects are limited to mild anaphylactoid reactions.

References

  • Daly FF, Fountain JS, Murray L et al.  Guidelines for the management of paracetamol poisoning in Australia and New Zealand – explanation and elaboration.  A consensus statement from clinical toxicologists consulting to the Australasian poisons information centres.  Medical Journal of Australia 2008; 188:296-301.
  • Kerr F, Dawson A, Whyte IM et al.  The Australasian Clinical Toxicology Investigators Collaboration randomized trial of different loading infusion rates of N-acetylcysteine. Annals of Emergency Medicine 2005; 45:409-13.
  • Prescott LF, Illingworth RN, & Critchley JA: Intravenous N-acetylcysteine: the treatment of choice for paracetamol poisoning. British Medical Journal 1979; 2:1097.

Toxicology Handbook

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About Mike Cadogan

Emergency physician with a passion for medical informatics and medical education. Co-founder of HealthEngine, iMeducate, and the GMEP. He writes more eclectically on the web as @sandnsurf | + Mike Cadogan | Contact