The efficacy of N-acetylcysteine as a specific antidote for
acetaminophen poisoning depends on its ability to stimulate glutathione
synthesis.2,3 Increasing evidence has shown the action
of N-acetylcysteine to be dey in microcirculatory blood flow and tissue
oxygenation via enhanced oxygen delivery/consumption.4
No randomized controlled trials comparing IV-NAC to O-NAC in children/adults
have been published.
Oral N-acetylcysteine is the only FDA approved antidote for acetaminophen
overdose in the United States. All usage of IV-NAC at present
IV-NAC is treatment of choice for acetaminophen poisoning in Europe.
The theoretic superiority of IV-NAC centers around fact that the most
severely poisoned patients develop early nausea and vomiting, making
oral treatment impractical.1,3
Adverse reaction to IV-NAC include local/diffuse erythema (usually
associated with loading dose), fever, dystonic reaction, and anaphylaxis.1
- Perry HE, Shannon MW. Efficacy of oral verses intravenous N-acetylcysteine
in acetaminophen overdose: Results of an open-label, clinical
trial. The Journal of Pediatrics 1998; 132:149-152.
- Miller RP, Roberts FJ, Tischer LJ. Acetaminophen Elimination Kinetics
in Neonates, Children, and Adults. Clinical Pharmacology and
Therapeutics 1976; 19:284-294.
- Smilkstein MJ, Bronstein AC, Linden C, et al. Acetaminophen Overdose:
A 48-hour Intravenous N-acetylcyteine treatment protocol. Annals
of Emergency Medicine 1991; 20:1058-1063.
- Harrison P, Wendon J, Gimson O, et al. Improvement By Acetylcysteine
of Hemodynamics and Oxygen Transport In Fulminant Hepatic Failure. New
England Journal of Medicine 1991; 324:1852-1857.