![]() Monitoring of patients with a should include repeated neurologic and hemodynamic assessment. ![]() Additionally, caution should always be used when intravenous NAC is prescribed and the amount of diluent is calculated. The total dose is 300 mg/kg delivered over 21 hours. Adults should receive 150 mg/kg administered for 45 minutes, followed by 50 mg/kg administered for 4 hours, followed by 100 mg/kg administered for 16 hours. AccessEmergency Medicine is a subscription-based. The most common anaphylactoid reactions include rash, flushing, and bronchospasm. Read this chapter of Critical Care Emergency Medicine online now, exclusively on AccessEmergency Medicine. However, caution should be used in patients who have experienced previous hypersensitivity or anaphylactoid reactions to intravenous NAC, as well as in patients with asthma. Intravenous NAC is indicated in patients who present with a history of acetaminophen overdose within the previous 8 to 10 hours, patients unable to tolerate oral NAC, and patients who present with evidence of fulminant hepatic failure. NAC replenishes hepatic glutathione and may also act as a glutathione substitute, combining directly with the toxic metabolite. In overdose, hepatic stores of glutathione are depleted and NAPQI binding to hepatocytes induces cell death and hepatic necrosis. Acetaminophen is metabolized to N-acetyl-p-benzoquinone imine (NAPQI), which is detoxified by conjugation with glutathione. However, if treated early, patients with acetaminophen poisoning generally recover uneventfully. Liver failure may occur in severe toxicity. Acetaminophen toxicity may occur acutely when supratherapeutic amounts are ingested purposefully or unintentionally. Acetaminophen is a commonly used analgesic and antipyretic agent, and its use is one of the most common causes of poisoning worldwide. Abstract N-acetylcysteine (NAC) is widely recognized as the antidote of choice for acetaminophen overdose.
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