Among high-risk acetaminophen overdoses with [APAP] x AT products >/= 10,000 mg-IU/L2 and starting IV acetylcysteine (NAC) > 8 h after OD, what were the outcomes of using a one-bag, standard concentration NAC protocol compared to the three-bag NAC protocol?
A retrospective study compared one-bag, standard concentration NAC (30 mg/mL given as bolus of 150 mg/kg/h x 1 hour followed by 15 mg/kg/h infusion) to the three-bag protocol.
The frequency of hepatotoxicity (peak AST or ALT > 1000 IU/L) was lower with 1-bag NAC (29% vs. 52%; p=0.043).
The mean peak transaminase activities were lower with 1-bag NAC (2143 IU/L vs. 4481 IU/L; p=0.026).
Frequency of coagulopathy (INR >/= 2) was lower with 1-bag NAC (23% vs 43%) but did not reach statistical significance (p=0.057).
Kartik R. Shah & Michael C. Beuhler (2021): Single bag high dose intravenous N-acetylcysteine associated with decreased hepatotoxicity compared to triple bag intravenous N-acetylcysteine in high-risk acetaminophen ingestions, Clinical Toxicology, DOI: 10.1080/15563650.2021.1979231
Submitted by: Michael Mullins, MD