Annals of Emergency Medicine
Volume 50, Issue 3 , Pages 272-279 , September 2007

A Prospective Evaluation of Shortened Course Oral N-Acetylcysteine for the Treatment of Acute Acetaminophen Poisoning

Presented at the North American Congress of Clinical Toxicology annual meeting, September 2005, Orlando, FL.

  • David P. Betten, MD

      Affiliations

    • Department of Emergency Medicine, Michigan State University College of Human Medicine, East Lansing, MI
    • Corresponding Author InformationAddress for correspondence: David P. Betten, MD, Department of Emergency Medicine, Sparrow Hospital, 1215 E Michigan Ave, PO Box 30480, Lansing, MI 48909-7980; 517-364-4120, fax 517-364-3725
    • ,
  • F. Lee Cantrell, PharmD

      Affiliations

    • California Poison Control System, San Diego Division, University of California, San Diego, School of Pharmacy, San Diego, CA
    • ,
  • Stephen C. Thomas, MD

      Affiliations

    • Department of Emergency Medicine, Naval Medical Center, San Diego, CA
    • ,
  • Saralyn R. Williams, MD

      Affiliations

    • Departments of Medicine and Emergency Medicine, Vanderbilt University, Nashville, TN
    • ,
  • Richard F. Clark, MD

      Affiliations

    • Department of Emergency Medicine, Division of Medical Toxicology, University of California San Diego, San Diego, CA.

Received 28 February 2006 ,Revised 1 November 2006 ,Accepted 7 November 2006.

References 

  1. Watson WA, Litovitz TL, Rodgers GC, et al. 2004 Annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med. 2005;23:589–666
  2. Rumack BH, Peterson RG. Acetaminophen overdose: incidence, diagnosis, and management in 416 patients. Pediatrics. 1978;62:898–903
  3. Lyons L, Studdiford JS, Sommaripa AM. Treatment of acetaminophen overdosage with N-acetylcysteine. N Engl J Med. 1977;296:174–175
  4. Smilkstein MJ, Knapp GL, Kulig KW, et al. Efficacy of oral N-acetylcysteine in the treatment of acetaminophen overdose: analysis of the National Multicenter Study (1976 to 1985). N Engl J Med. 1988;319:1557–1562
  5. Hamlyn AN, James O, Douglas AP. The spectrum of paracetamol (acetaminophen) overdose: clinical and epidemiological studies. Postgrad Med J. 1978;54:400–404
  6. James LP, Farrar HC, Darville TL, et al. Elevation of serum interleukin 8 levels in acetaminophen overdose in children and adolescents. Clin Pharmacol Ther. 2001;70:280–286
  7. Keays R, Harrison PM, Wendon JA, et al. Intravenous acetylcysteine in paracetamol induced fulminant hepatic failure: a prospective controlled trial. BMJ. 1991;303:1026–1027
  8. Aruoma OI, Halliwell B, Hoey BM, et al. The antioxidant action of N-acetylcysteine: its reaction with hydrogen peroxide, hydroxyl radical, superoxide, and hypochlorous acid. Free Radic Biol Med. 1989;6:593–597
  9. Prescott LF, Illingworth RN, Critchley JA, et al. Intravenous N-acetylcysteine: the treatment of choice for paracetamol poisoning. BMJ. 1979;2:1097–1100
  10. Sivilotti ML, Yarema MC, Juurlink DN, et al. A risk quantification instrument for acute acetaminophen overdose patients treated with N-acetylcysteine. Ann Emerg Med. 2005;46:263–271
  11. Buckley NA, Whyte IM, O’Connell DL, et al. Oral or intravenous N-acetylcysteine: which is the treatment of choice for acetaminophen (paracetamol) poisoning?. J Toxicol Clin Toxicol. 1999;37:759–767
  12. Smilkstein MJ, Bronstein AC, Linden C, et al. Acetaminophen overdose: a 48-hour intravenous N-acetylcysteine treatment protocol. Ann Emerg Med. 1991;20:1058–1063
  13. Woo OF, Mueller PD, Olson KR, et al. Shorter duration of oral N-acetylcysteine therapy for acute acetaminophen overdose. Ann Emerg Med. 2000;35:363–368
  14. Yip L, Dart RC. A 20-hour treatment for acute acetaminophen overdose. N Engl J Med. 2003;348:2471–2472
  15. Tsai CL, Chang WT, Weng TI, et al. A patient-tailored N-acetylcysteine protocol for acute acetaminophen intoxication. Clin Ther. 2005;27:336–341
  16. Kozer E, McGuigan M. Treatment strategies for early presenting acetaminophen overdose: a survey of medical directors of poison centers in North America and Europe. Hum Exp Toxicol. 2002;21:123–127
  17. Jollow DJ, Mitchell JR, Potter WZ, et al. Acetaminophen-induced hepatic necrosis, II: role of covalent binding in vivo. J Pharmacol Exp Ther. 1973;187:195–202
  18. Bond DR, Novak JE. The human and economic cost of paracetamol (acetaminophen) overdose. Pharmacoeconomics. 1995;8:177–181

 Supervising editor: Richard C. Dart, MD, PhDAuthor contributions: DPB was principal investigator. DPB, FLC, SRW, and RFC conceived and designed the study. DPB, SCT, and RFC identified eligible study participants and collected and recorded all data. SRW and RFC supervised data collection and analysis. DPB drafted the article, and FLC, SRW, and RFC contributed substantially to its revisions. DPB is responsible for the paper as a whole.Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article, that may create any potential conflict of interest. The authors have stated that no such relationships exist. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement.Available online March 30, 2007.Reprints not available from the authors.

PII: S0196-0644(06)02533-9

doi: 10.1016/j.annemergmed.2006.11.010

Annals of Emergency Medicine
Volume 50, Issue 3 , Pages 272-279 , September 2007

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