N-acetylcysteine for Acetaminophen toxicity

Intravenous Administration

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         Administer 150 mg/kg (up to 15 g) intravenously in D5W 200 ml over 15 minutes. Follow with 50 mg/kg (up to 5 g) in D5W 500 ml over 4 hours, and then administer 100 mg/kg (up to 10 g) in D5W 1000 ml over 16 hours.

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Oral Administration

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         Oral loading dose 140 mg/kg follow by oral maintenance dose 70 mg/kg every 4 hours x17doses If the patient has already received activated charcoal, perform gastric lavage to remove the charcoal from the stomach first, and then increase the NAC dose by approximately 30%.

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Adverse effect

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• Oral NAC can cause nausea, vomiting, diarrhea, flatulence, and reflux.

• IV NAC may lead to anaphylactoid reactions in up to 18% of patients, which is not an issue with the oral form. Most reactions are mild (6%) or moderate (10%), with severe cases like bronchospasm and hypotension being rare (1%).