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Delays during the administration of acetylcysteine for the treatment of paracetamol overdose

Lookup NU author(s): Professor Simon Thomas



This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).


Background: The licensed intravenous acetylcysteine regimen for treating paracetamol overdose in most countries uses three separate infusions over 21 hours. This complex regimen, requiring different infusion concentrations and rates, has been associated with administration errors. The aim was to assess the extent of administration delays occurring during this acetylcysteine regimen.Method: A 6-month retrospective observational study was conducted at three English teaching hospitals with clinical toxicology services from October 2014. Patients aged 16-years and over treated with intravenous acetylcysteine for paracetamol overdose were included. The start times for infusions were recorded and the delays compared to the prescribed infusion times were calculated. Anaphylactoid reactions, intravenous cannula problems, overdose intent and smoking status were recorded to assess their contribution to delays.Results: From 263 cases identified, 198 met study inclusion criteria. The median time between the start of infusions 1 and 3 was delayed from the intended 5 hours by a median (IQR) of 90 (50-163) minutes, with 135 (68%) cases delayed by more than one hour. Significantly longer delays were observed in patients with anaphylactoid reactions (median delay 267 (217-413) minutes, n=8) and accidental / supra-therapeutic overdose (median delay 170 (95-260) minutes, n=29). There were no significant differences between smokers and non-smokers and for patients with intravenous cannula problems. Conclusion: Long delays were identified during the three-infusion acetylcysteine regimen for the treatment of paracetamol overdose. Delays were of clinical significance and could lead to periods of sub-therapeutic plasma acetylcysteine concentrations and potentially avoidable hepatotoxicity, as well as delaying hospital discharge.

Publication metadata

Author(s): Bailey GP, Najafi J, Elamin MEMO, Waring WS, Thomas SHL, Archer JRH, Wood DM, Dargan PI

Publication type: Article

Publication status: Published

Journal: British Journal of Clinical Pharmacology

Year: 2016

Volume: 82

Issue: 5

Pages: 1358-1363

Print publication date: 01/11/2016

Online publication date: 14/07/2016

Acceptance date: 09/07/2016

Date deposited: 11/07/2016

ISSN (print): 0306-5251

ISSN (electronic): 1365-2125

Publisher: Wiley-Blackwell


DOI: 10.1111/bcp.13063


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