Modified two step N-acetylcysteine dosing regimen for the treatment of acetaminophen overdose a safe alternative

Figures & data

Table 1. Patient demographics and overdose characterization.

Variable	(n = 79)
Age, years
Mean (SD)	42 (17)
Minimum–Maximum	18–83
Male	38%
Race
African American	8%
Caucasian	86%
Hispanic	4%
Past Medical History
Opioid Abuse	15%
Alcohol (chronic)	27%
Alcohol (acute)	10%
Psychiatric Disorder	82%
Previous Suicidal Ideations or Attempts	51%
Stimulant Abuse	13%
Chronic Pain	24%
End Stage Renal Disease	1%
Prior APAP overdose	2%
Chronic APAP Ingestion*	12%
Overdose mixed with other substances	75%
Opioids	32%
Diphenhydramine	23%
Alcohol	17%
Acute Intentional Overdose	90%
Acute Accidental Overdose	1%
Received Activated Charcoal	26%
Acetaminophen Amount Ingested, g, median (quartiles)	12 (99–325)
Hours Since Acetaminophen Ingestion, median (quartiles)	7.5 (5–12)
N-Acetylcysteine Treatment Duration (hours), median (quartiles)	32.0 (25–49)
Cumulative N-Acetylcysteine dose all patients (g), median (quartiles)	51 (37–75)
Required >21 hours N-Acetylcysteine of therapy	58%

*Chronic acetaminophen ingestions defines as resulting over a greater than eight hour period. g = gram.

Table 2. Treatment outcomes.

Variable	n = 79
Delays N-acetylcysteine in bags >1 hour	11%
Adverse effects documented, N (%)
Cutaneous, Gastrointestinal Respiratory, Angioedema, Cardiovascular	0 (0.0%)
Treatments given during N-Acetylcysteine infusion, N (%)
Antiemetic	3 (12%)
Bronchodilator	2 (8%)
Epinephrine, Antihistamine, Steroids	0 (0%)
NAC stopped	0 (0%)
Peak Acetaminophen Concentrations (mcg/mL)
All, median (quartiles)	103.9 (39.2–172.9)
<15	11%
>150	32%
>300	5%
>500	1%
Peak AST (U/L)
All, median (quartiles)	31 (18–174)
>100	29%
>1000	21%
Peak INR, median (quartiles)	1.2 (1.1–1.5)
Peak Serum Creatinine (mcg/mL), median (quartiles)	0.90 (0.70–1.20)
Mortality, in-hospital	5%
Renal replacement therapy during admission	6%
Liver Transplant	1%