Be alert to the development of an acute Anaphylactoid reaction following IV administration
- Precursor of glutathione depleted by paracetamol derived NAPQI
- See Paracetamol/Acetaminophen toxicity entry
- Those calculated to have ingested >75mg/kg or staggered overdose
- Those with a blood paracetamol level above the treatment threshold
- Those within 8h of ingestion do not wait for level if the patient
presents close to or after this time as the efficacy of acetylcysteine will
decline rapidly after 8h.
- Other uses: To reduce the risk of AKI following administration of IV contrast (contrast nephropathy) and to reduce sputum viscosity as it liquefies mucus and can aid sputum clearance
Indications/Dose for Paracetamol poisoning (max weight 110 kg)
|Name||Weight adjusted dose up to 110 Kg||Frequency||Route|
|Bag 1: N-Acetylcysteine||150 mg/kg in 200 ml 5% Dextrose over 1 hr ||Stat||IV|
|Bag 2: N-Acetylcysteine||50 mg/kg in 500 ml 5% Dextrose over 4 hours||Stat||IV|
|Bag 3: N-Acetylcysteine||100 mg/kg in 1000 ml 5% Dextrose over 16 hours||Stat||IV|
- Allergy - rash, Flushing, bronchospasm (give bronchodilator)
- Anaphylactoid reaction - if given too quickly. Slow IV Infusion and continue cautiously.
- Ensure access to resuscitation equipment.
- Asthma - be ready to treat any bronchospasm