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Two versus Three Infusion Regimens of N-Acetylcysteine for Acetaminophen Overdose

Authors :
Shadi Tamur
Bader Alyahya
Faisal Alsani
Ammar Abdulraheem Bahauddin
Maryam Aljaid
Sultan Al-Malki
Ahmad Alzahrani
Abdullah Khayat
Anwar Shams
Dominic S. Chalut
Source :
Pediatric Reports, Vol 16, Iss 1, Pp 232-242 (2024)
Publication Year :
2024
Publisher :
MDPI AG, 2024.

Abstract

Background: Acetaminophen overdose is a common clinical condition, often leading to liver toxicity. Current treatments involve the three-infusion N-Acetylcysteine (NAC) regimen (FDA-labeled), which may be complex, time-consuming, and need to be changed. An alternative uses two infusions instead, which offers possible advantages regarding simplicity and administration errors. This study sought to compare the respective efficacies and safety outcomes when treating acute acetaminophen overdose among children and adolescents. Methods: At Montreal Children’s Hospital, a retrospective study was conducted comparing pre-2003 FDA-labelled three-infusion NAC therapy with a two-infusion regimen. Information was collected regarding patient demographics, NAC administration details, errors, rates of hepatotoxicity, and adverse reactions, and the statistical test Chi-square test was employed to obtain the results. Results: A total of 126 patients met the inclusion criteria. Of these patients, 65 received a two-infusion regimen, and 61 patients received the FDA-labeled regimen. The two-infusion group experienced significantly fewer administration errors (4 errors vs. 23 errors; p < 0.001), while the rates of hepatotoxicity between them were similar. There were no instances of liver transplantation or mortality due to either regimen. Adverse reactions occurred equally frequently between both regimens with no discernible difference—the meantime to administer NAC was 9 h for the two-infusion regimen and 8.5 h for FDA-labeled regimen groups, respectively. Three cases of hepatitis were successfully treated with timely NAC therapy, and no liver transplantation or mortality occurred. Adverse reactions, including anaphylactoid reactions, were observed in both groups but were resolved when temporarily stopped and restarted at a slower infusion rate. Conclusions: The two-infusion NAC regimen proved similar efficacy at protecting liver damage and improving patient outcomes compared to its FDA-labeled three-stage counterpart, with significantly fewer administration errors for this version of NAC treatment, suggesting potential advantages in terms of safety and simplicity. Future research should investigate larger cohorts and more variables to validate these results further and optimize the management of acetaminophen overdose cases; further investigation should focus on dosing strategies, personalized approaches, and long-term patient care in this context.

Details

Language :
English
ISSN :
20367503
Volume :
16
Issue :
1
Database :
Directory of Open Access Journals
Journal :
Pediatric Reports
Publication Type :
Academic Journal
Accession number :
edsdoj.4b3cd0f9fc5f4ef3990e1faae3c101c3
Document Type :
article
Full Text :
https://doi.org/10.3390/pediatric16010020