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Direct comparison of 20-hour IV, 36-hour oral, and 72-hour oral acetylcysteine for treatment of acute acetaminophen poisoning.
Am J Ther 2013; 20(1):37-40AJ

Abstract

There is no general consensus among clinicians on the superior route or duration of treatment with N-acetylcysteine (NAC) for acute acetaminophen (APAP) poisoning, and head-to-head studies comparing intravenous (IV) and oral NAC have not been done. Recent 20-hour IV NAC protocol failures in the United States prompted some to question its safety. Our objective was to determine if treatment with the 20-hour IV NAC protocol results in clinical outcomes different from the longer 36-hour oral or 72-hour oral NAC protocols in cases of acute APAP poisoning. We performed a retrospective analysis of all consecutive cases of acute APAP overdose where NAC treatment was initiated within 8 hours of ingestion between January 1, 2002, and December 31, 2007. Outcomes were survival, transplant, and death; secondary outcomes were based on King's College Criteria; interrater reliability was calculated with a kappa score. Out of 4642 cases of APAP overdose, 795 met study inclusion criteria: 213 were treated with 20-hour IV protocol, 213 with the 36-hour oral protocol, and 369 with the 72-hour oral protocol. The mean age in these groups was 25 years [95% confidence interval (CI): 22-26], 26 years (95%CI: 23-29), and 27 years (95%CI: 25-28), respectively. The mean 4-hour APAP concentration was 199 μg/mL (95%CI: 188-211), 174 μg/mL (95%CI: 164-184), and 205 μg/mL (95%CI: 195-216), respectively. No cases of transplant or death occurred, and secondary outcomes were rare. When administered within 8 hours of acute APAP poisoning, the 20-hour IV treatment protocol was as effective as the longer 36-hour oral and 72-hour oral treatment protocols. Further study is needed to determine outcome differences between IV and oral NAC when treatment is initiated >8 hours after overdose or in cases of coingestion with other drugs.

Authors+Show Affiliations

Department of Emergency Medicine, Advocate Christ Medical Center, Oak Lawn, Illinois, USA.No affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Evaluation Studies
Journal Article

Language

eng

PubMed ID

23299230

Citation

Williamson, Kelly, et al. "Direct Comparison of 20-hour IV, 36-hour Oral, and 72-hour Oral Acetylcysteine for Treatment of Acute Acetaminophen Poisoning." American Journal of Therapeutics, vol. 20, no. 1, 2013, pp. 37-40.
Williamson K, Wahl MS, Mycyk MB. Direct comparison of 20-hour IV, 36-hour oral, and 72-hour oral acetylcysteine for treatment of acute acetaminophen poisoning. Am J Ther. 2013;20(1):37-40.
Williamson, K., Wahl, M. S., & Mycyk, M. B. (2013). Direct comparison of 20-hour IV, 36-hour oral, and 72-hour oral acetylcysteine for treatment of acute acetaminophen poisoning. American Journal of Therapeutics, 20(1), pp. 37-40. doi:10.1097/MJT.0b013e318250f829.
Williamson K, Wahl MS, Mycyk MB. Direct Comparison of 20-hour IV, 36-hour Oral, and 72-hour Oral Acetylcysteine for Treatment of Acute Acetaminophen Poisoning. Am J Ther. 2013;20(1):37-40. PubMed PMID: 23299230.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Direct comparison of 20-hour IV, 36-hour oral, and 72-hour oral acetylcysteine for treatment of acute acetaminophen poisoning. AU - Williamson,Kelly, AU - Wahl,Michael S, AU - Mycyk,Mark B, PY - 2013/1/10/entrez PY - 2013/1/10/pubmed PY - 2013/6/19/medline SP - 37 EP - 40 JF - American journal of therapeutics JO - Am J Ther VL - 20 IS - 1 N2 - There is no general consensus among clinicians on the superior route or duration of treatment with N-acetylcysteine (NAC) for acute acetaminophen (APAP) poisoning, and head-to-head studies comparing intravenous (IV) and oral NAC have not been done. Recent 20-hour IV NAC protocol failures in the United States prompted some to question its safety. Our objective was to determine if treatment with the 20-hour IV NAC protocol results in clinical outcomes different from the longer 36-hour oral or 72-hour oral NAC protocols in cases of acute APAP poisoning. We performed a retrospective analysis of all consecutive cases of acute APAP overdose where NAC treatment was initiated within 8 hours of ingestion between January 1, 2002, and December 31, 2007. Outcomes were survival, transplant, and death; secondary outcomes were based on King's College Criteria; interrater reliability was calculated with a kappa score. Out of 4642 cases of APAP overdose, 795 met study inclusion criteria: 213 were treated with 20-hour IV protocol, 213 with the 36-hour oral protocol, and 369 with the 72-hour oral protocol. The mean age in these groups was 25 years [95% confidence interval (CI): 22-26], 26 years (95%CI: 23-29), and 27 years (95%CI: 25-28), respectively. The mean 4-hour APAP concentration was 199 μg/mL (95%CI: 188-211), 174 μg/mL (95%CI: 164-184), and 205 μg/mL (95%CI: 195-216), respectively. No cases of transplant or death occurred, and secondary outcomes were rare. When administered within 8 hours of acute APAP poisoning, the 20-hour IV treatment protocol was as effective as the longer 36-hour oral and 72-hour oral treatment protocols. Further study is needed to determine outcome differences between IV and oral NAC when treatment is initiated >8 hours after overdose or in cases of coingestion with other drugs. SN - 1536-3686 UR - https://www.unboundmedicine.com/medline/citation/23299230/Direct_comparison_of_20_hour_IV_36_hour_oral_and_72_hour_oral_acetylcysteine_for_treatment_of_acute_acetaminophen_poisoning_ L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=linkout&SEARCH=23299230.ui DB - PRIME DP - Unbound Medicine ER -