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N-Acetylcysteine (Parvolex)

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Anaesthetics and Critical Care

Obstetrics Gynaecology

Trauma and Orthopaedics

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Urology

Version Jan 2023

Be alert to the development of an acute Anaphylactoid reaction following IV administration

About : Always check the BNF link here

Precursor of glutathione depleted by paracetamol derived NAPQI
See Paracetamol/Acetaminophen toxicity entry

Indications

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

Side effects

Allergy - rash, Flushing, bronchospasm (give bronchodilator)
Anaphylactoid reaction - if given too quickly. Slow IV Infusion and continue cautiously.
Ensure access to resuscitation equipment.

Cautions

Asthma - be ready to treat any bronchospasm

References

Acetylcysteine at BNF

PLEASE NOTE LEGAL ADVICE: The contents are under continuing development and improvements and may contain errors of omission or fact. The official launch will be at the end of 2018. Feedback vital and always welcome at drokane at gmail.com. This is not to be used for the assessment, diagnosis or management of patients. It should not be regarded as medical advice. It is only for educational purposes. Please adhere to your local protocols. If you are unwell please seek healthcare advice from your doctor. This does not replace senior or specialist advice. If you do not accept this then please do not use the website. If you need medical advice, please consult a doctor or other appropriate medical professional. If you are a medical professional and you need advice then speak to your senior or colleagues.

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