Paracetamol (acetaminophen) overdose is a common cause of drug-induced hepatocellular injury and represents an important clinical emergency requiring timely evaluation and evidence-based management. N-acetylcysteine (NAC) remains the established antidote for preventing the progression of hepatic injury when administered promptly. We describe the case of an 18-year-old female who intentionally ingested eight tablets of paracetamol (650 mg each; total dose 5.2 g) and four tablets of cetirizine (10 mg each) following psychosocial distress. On presentation, she reported abdominal pain and had a history of transient altered consciousness prior to hospital arrival. Initial biochemical evaluation demonstrated mild hepatocellular injury, with serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels of 250 IU/L and 300 IU/L, respectively, while serum bilirubin and coagulation parameters (PT/INR) remained within normal limits, indicating the absence of acute liver failure. Following clinical assessment, the patient underwent gastric decontamination and received the standard intravenous NAC regimen, supportive therapy, serial monitoring of liver function, and comprehensive psychiatric evaluation. Liver enzyme concentrations progressively declined during hospitalization, reaching AST 60 IU/L and ALT 70 IU/L by day 3, with complete clinical recovery and no evidence of hepatic complications. Psychiatric assessment identified underlying psychosocial factors contributing to the intentional overdose, and appropriate pharmacological treatment and follow-up were initiated before discharge. This case demonstrates that favorable outcomes can be achieved through early risk assessment, guideline-directed NAC therapy, serial biochemical monitoring, and multidisciplinary management addressing both the toxicological and psychosocial aspects of intentional paracetamol overdose.

Despite significant advancements in obstetric care, the incidence of preeclampsia remains a substantial public health challenge, and effective strategies to prevent the disease progression remain limited, particularly in low-resource settings. N-acetylcysteine (NAC), an antioxidant and glutathione precursor, has demonstrated anti-inflammatory and vasodilatory effects, making it a promising candidate for repurposing. However, robust evidence from well-powered randomized controlled trials is lacking.

Huachansu (HCS) tablets, prepared from dried toad skin through water decoction and ethanol extraction, possess detoxifying and analgesic effects and are clinically used in the treatment of advanced tumors. However, the in vivo metabolism of HCS tablets has not been systematically investigated. In this study, a comprehensive analysis strategy based on ultra-performance liquid chromatography quadrupole time-of-flight mass spectrometry (UPLC-ESI-QTOF/MSE) was established for screening and identifying the prototype components and metabolites of HCS tablets in rat urine and feces. A total of 28 prototype components (16 bufadienolides, six alkaloids, four amino acids and peptides, two nucleosides) and 64 metabolites (44 bufadienolide-related metabolites and 20 alkaloid-related metabolites) were identified in the urine and feces of rats treated with HCS tablets. Based on the analysis of 64 metabolites, the metabolic processes of HCS tablets in rats mainly include desaturation, reduction, dehydroxylation, hydroxylation, hydration, dehydration, glucuronidation, methylation, acetylcysteine conjugation, acetylcysteine-S conjugation, and other related conjugation reactions. This approach enabled the rapid identification of HCS-related exogenous components in rat urine and feces, helping to elucidate the active substances and facilitate mechanistic research.

Intravenous use of methcathinone synthesized at home from over-the-counter medications containing pseudoephedrine or ephedrine poses significant health risks, including neurotoxicity, severe infections, and, in some cases, fatal outcomes. This study explores the public health implications of this hazardous practice. Post-mortem femoral blood and vitreous humor samples were analyzed using UHPLC-QqQ-MS/MS. The method enabled differentiation of ephedrine (a metabolite of methcathinone in this context) from pseudoephedrine (a precursor), along with the identification of relevant metabolites. A literature review was also conducted to contextualize associated health risks. The validated method accurately quantified methcathinone, pseudoephedrine, ephedrine, and identified their metabolites. The simultaneous detection of the final product and unreacted precursor supported the hypothesis of chronic intravenous use of homemade methcathinone. Literature data emphasized the risks of manganese-induced encephalopathy, injection-related infections, and the harmful effects of intravenously administered tablet excipients. These issues disproportionately affect marginalized and high-risk populations. This case highlights the diagnostic value of the method and its importance for monitoring the health impacts of illicit stimulant use. Effective responses should include public education, harm reduction strategies, surveillance of emerging drug trends, and, above all, the application of advanced analytical methods capable of comprehensive evaluation in such cases.

N-acetylcysteine (NAC) is a derivative of cysteine with potent mucolytic and antioxidant properties. However, the pharmacokinetics of NAC tablets remain unclear in healthy Chinese subjects. This study aimed to assess the pharmacokinetics, bioequivalence, and safety of a domestically manufactured NAC tablet (600 mg) compared with the reference formulation in healthy Chinese volunteers under both fasting and fed conditions. A single-dose, randomized, open-label, two-formulation, crossover bioequivalence study was conducted, using a two-period, two-sequence design under fasting conditions and a four-period, fully replicated crossover design under fed conditions. Blood samples were collected at predetermined time points and analyzed using a validated liquid chromatography-tandem mass spectrometry method. The 90% confidence intervals for the geometric mean ratios (test/reference) of the maximum plasma concentration, the area under the concentration-time curve from time zero to the last measurable concentration, and from time zero to infinity were all within the accepted bioequivalence range of 80%-125%. Furthermore, both the test and reference formulations were well tolerated, and no serious adverse events were reported. These results demonstrate that the test and reference NAC tablets are bioequivalent and exhibit similar pharmacokinetic profiles and safety in healthy Chinese subjects under both fasting and fed conditions.

Small occasional doses of cetirizine are probably acceptable during breastfeeding. Larger doses or more prolonged use may cause drowsiness and other effects in the infant or decrease the milk supply, particularly in combination with a sympathomimetic such as pseudoephedrine or before lactation is well established.[1,2] International guidelines recommend cetirizine as an acceptable choice if an antihistamine is required during breastfeeding. Cetirizine has been used successfully in cases of persistent pain of the breast during breastfeeding.[3] Ophthalmic use of cetirizine by the mother should pose little risk to the breastfed infant. To substantially diminish the amount of drug that reaches the breastmilk after using eye drops, place pressure over the tear duct by the corner of the eye for 1 minute or more, then remove the excess solution with an absorbent tissue.

Lamotrigine (LTG) is an antiepileptic drug that stabilizes neuronal membranes by inhibiting excitatory neurotransmitter release, thereby reducing neuronal excitation. Various factors can contribute to its metabolic dysfunction. A 22-year-old female with bipolar disorder presented after intentionally ingesting 216 tablets, including LTG (4,100 mg), prescribed antipsychotics, over-the-counter cold medicine containing acetaminophen (27 g), and alcohol. She arrived at the hospital approximately one-hour post-ingestion in a confused state, with mild transaminase elevation but no significant electrocardiographic abnormalities. Initial management included activated charcoal, N-acetylcysteine therapy, and intravenous fluids. Despite these interventions, she deteriorated to a comatose state by hospital day two, accompanied by a mild skin rash later diagnosed as urticaria. Her hepatic function and consciousness gradually improved, with transaminase normalization and full neurological recovery by day six. She was discharged on day seven without residual deficits. Serial LTG serum measurements at 13, 55, and 79 hours post-ingestion (16.10 mg/L, 12.39 mg/L, and 6.84 mg/L, respectively) revealed a non-linear elimination pattern, with an estimated half-life of ~100 hours between the first two measurements. However, by the third measurement, elimination aligned with previously reported pharmacokinetics. The patient's young age, normal BMI, absence of hepatic disease, and minimal interaction potential with co-ingested antipsychotics did not explain the delayed LTG clearance. We hypothesize that hepatic metabolic pathway saturation led to this non-linear pharmacokinetic behavior. The resolution of delayed elimination corresponded with hepatic enzyme normalization. In drug overdose cases, prolonged consciousness disturbance may indicate an extended drug half-life due to metabolic dysfunction. If recovery exceeds expectations, further evaluation is warranted to identify and address potential causes.

N-acetyl-L-cysteine (NAC) as a class of thiols is commonly used in the treatment of lung diseases, detoxification and prevention of liver damage. In this paper, 4-mercaptobenzoic acid (4-MBA) coated and polyvinylpyrrolidone (PVP) attached copper nanoclusters (4-MBA@PVP-CuNCs) were successfully synthesized using a simple one-pot method with an absolute quantum yield of 10.98 %, and its synthetic conditions (like effects of single/double ligands and temperature) were studied intensively. Then Hg2+ could quench the fluorescence of the 4-MBA@PVP-CuNCs and its fluorescence was restored with the addition of NAC. Based on the above principles, an off-on switching system was established to detect NAC. That is, the 4-MBA@PVP-CuNCs-Hg probe was prepared by adding Hg2+ to switch off the fluorescence of the CuNCs by static quenching, and then NAC was added to switch on the fluorescence of the probe based on the chelation of NAC and Hg2+. Moreover, the effects of metal ion types and mercury ion doses for the probe construction were also further discussed. The method showed excellent linearity in the range of 0.05-1.25 µM and low detection limit of 16 nM. Meanwhile, good recoveries in real urine, tablets and pellets were observed, which proved the reliability of the method and provided a convenient, fast and sensitive method for NAC detection.