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

The Clinical Management of Acetaminophen Poisoning in a Community Hospital System: Factors Associated with Hospital Length of Stay

“…The average time from earliest laboratory evidence of clearance to hospital discharge was 35 h. This calculation was performed in an attempt to measure the potential impact of routine use of patient-tailored NAC treatment protocols. [5,6,10] The maximum potential impact in this cohort was 157 hospital admission days per year (Total earliest laboratory clearance to DC hours/24 h/3.5 years). While it is clear that patients could never be discharged immediately upon laboratory clearance, this represents an area where meaningful efficiency improvements could be made in the management of APAP overdose patients.…”

“…In order to estimate potential times to completion of NAC therapy using patient-tailored protocols [5,6,10], a theoretical model for predicting when patients might have been cleared from antidotal therapy was developed. The "earliest laboratory evidence of clearance time" was defined as the time when available labs demonstrated that the APAP level was undetectable (less than 10 μg/mL) and the patient's liver transaminases were normal (AST<60 IU/L, ALT<60 IU/L).…”

“…Most protocols depend on an undetectable serum APAP level and normal (or resolving) liver enzymes as clearance criteria. A shortened-course of oral NAC for selected cases of APAP poisoning has been recommended by practitioners from the California Poison Control System (CPCS) since before 2000 [5,6], though no routine policy is in place.…”

“…The traditional treatment protocol for APAP poisoning in the USA consists of a 72-h course of oral N-acetylcysteine (NAC) [2][3][4]. More recently experts have recommended patient-tailored approaches to oral NAC treatment [5][6][7][8][9][10][11][12]. These protocols seek to truncate NAC therapy for patients showing evidence of recovery.…”

ACMT Position Statement: Duration of Intravenous Acetylcysteine Therapy Following Acetaminophen Overdose

“…The FDA approved a 72-h oral NAC regimen in 1985. However, evidence supports using shorter oral NAC courses provided that liver enzymes and synthetic function are normal or improving, and plasma APAP concentration is undetectable [1,2]. I n t r a v e n o u s N A C ( A c e t a d o t e ® , C u m b e r l a n d Pharmaceuticals) was approved by the FDA in 2004 and is indicated to prevent or lessen hepatic injury after potentially toxic APAP ingestion.…”