![]() Analysis of the national multicenter study (1976 to 1985). Efficacy of oral N-acetylcysteine in the treatment of acetaminophen overdose. Smilkstein MJ, Knapp GL, Kulig KW, Rumack BH. Intravenous N-acetylcystine: the treatment of choice for paracetamol poisoning. Prescott LF, Illingworth RN, Critchley JA, Stewart MJ, Adam RD, Proudfoot AT. Cysteamine, methionine, and penicillamine in the treatment of paracetamol poisoning. Prescott LF, Sutherland GR, Park J, Smith IJ, Proudfoot AT. Treatment of paracetamol (acetaminophen) poisoning with N-acetylcysteine. Prescott LF, Park J, Ballantyne A, Adriaenssens P, Proudfoot AT. Acetaminophen-induced hepatic injury: protective role of glutathione in man and rationale for therapy. Mitchell JR, Thorgeirsson SS, Potter WZ, Jollow DJ, Keiser H. Many antidotes are rarely used, prone to go out of stock and are expensive. ![]() insulin, atropine), but when used as ‘antidotes’ much higher doses may be required to correct the disturbance physiology resulting from intoxication. This article discusses these data and proposes a logical therapy for increasing NAC dosing which now requires clinical trial testing.Īcetylcysteine antidotes clinical toxicology large overdose paracetamol poisoning treatment. Some antidotes have established roles in other diseases (e.g. New biomarkers also show the possibility of early identification of patients at risk of liver injury who might also benefit from increased intensity treatment. As shown above, mice given an acetaminophen overdose (APAP only) had extremely high liver toxicity (as measured by the level of an enzyme called ALT). Clinical trial evidence supporting shorter NAC dosing now allows the possibility for intensifying treatment without the risk of very high rates of ADRs. Additionally, it is more effective than NAC at reducing liver toxicity in mice four hours after the acetaminophen overdose. ![]() Recent case series have shown an increased toxicity from high doses of paracetamol, even in those receiving prompt NAC therapy, particularly in patients above the 300 mg/L nomogram treatment line. Paracetamol poisoning continues to be a worldwide problem and, despite the availability of an effective antidote, acetylcysteine (NAC), the optimal way to use this antidote, particularly following very large doses of paracetamol, has not been established.
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