The hepatoprotective effect of N-acetylcysteine with repeated toxic acetaminophen ingestions: a case report

Figures & data

Table 1. All serum APAP concentrations from overdose encounters to authors’ institution appear in chronologic order with “Day 0” representing the beginning of a twelve-month period with an increased frequency of overdoses. Time₁ is four hours post-ingestion, unless otherwise noted. Repeat measured APAP serum concentrations appear as [APAP]₂ or [APAP]₃ with the corresponding time post-ingestion. A “+” indicates NAC administration. AST, ALT, and INR represent the highest observed values for each encounter.

Day	[APAP]1 (mcg/mL)	Time1 (h)	[APAP]2 (mcg/mL)	Time2 h	[APAP]3(mcg/mL)	Time3 h	NAC	AST (IU/L)	ALT (IU/L)	INR	Apparent t1/2 (h)
−2681	12.6							25	42	1.0
−2540	153.1		<10	34			+	21	11	1.0
−1754	87.8							46	21
–973	355.5	1	<10	16.5			+	24	25	2.3
–84	162		<3	22.5			+	28	14	1.1
0	96							11	12	0.9
30	249	6.5	<3	25			+	10	15	1.0
43	162		<3	26			+	7	12	1.0
52	55		45	14	<3	37.5	+	23	13	1.0	**
*64	152						+	13		1.0
71	234		<3	27			+	15	13	1.0
76	78							11	14	0.9
78	154		<3	24			+	7	14	1.0
85	218		<3	24			+	8	19	1.2
90	119							11	16
100	142							5	12	1.0
106	257		<3	25			+	9	15	1.0
109	201		<3	25			+	8	11
113	38
119	48							8	12	0.9
125	197		22	8	<3	14	+	8	12	1.1	1.3
132	67							11	13
160	224		42	12.5	<3	27.5	+	5	<10	1.2	3.5
163	25		<3	15				11	14	1.0
170	113
192	284						+	8	<10	1.1
198	>337		<3	25			+	140	158	1.0
205	27							10	21	1.0
249	152		16	11.5	<3	27	+	10	12	1.2	2.3
267	308		16	18	3	23	+	10	<10	1.1	3.3
349	234		<3	36.5			+	12	11	1.1

* This encounter was at another hospital. Data are from Toxicall^®.

** This apparent half-life was implausible (>31 h) and likely reflects continued absorption after four hours.