To the Editor:
We appreciate the comments from Dr. Lucyk and colleagues, and we generally agree with their approach to patients with paracetamol (APAP) poisoning.
As they point out, we did not explicitly state that APAP had to be undetectable before discontinuing N-acetylcysteine (NAC). However, there is a strong consensus on this as one of the necessary conditions for stopping NAC.Citation1 We take this opportunity to clarify that this was the practice in our hospital throughout the period of data collection and that it remains our practice today.
In their 2007 commentary, Dart and Rumack suggested that NAC may be stopped in a patient who is clinically well, has an APAP concentration that is “zero or near zero,” and has normal or improving alanine aminotransferase (ALT) concentrations. Our approach is consistent with this recommendation. Dart and Rumack mentioned “impressive improvement” and offered an example of a decline in ALT concentration from 1500 IU/L to 500 IU/L without otherwise defining the term.
Our data suggest a potential tool for identifying resolution of hepatic injury. However, given both the retrospective study design and the small number of patients in our data set, our findings warrant validation with a larger data set or a prospective trial.
Declaration of interest
The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
Reference
- Dart RC, Rumack BH. Patient-tailored acetylcysteine administration. Ann Emerg Med 2007; 50:280–281.