• David P Betten, Elizabeth E Burner, Stephen C Thomas, Christian Tomaszewski, and Richard F Clark.
• Department of Emergency Medicine, Sparrow Hospital, Michigan State University College of Human Medicine, East Lansing, MI 48912, USA. bettend@msu.edu
• J Med Toxicol. 2009 Dec 1;5(4):183-90.

IntroductionThe use of less than the traditional 72-hour course of oral N-acetylcysteine has been an alternative treatment option following potentially toxic acute and chronic acetaminophen ingestions felt to be at low risk of developing hepatotoxicity. While clinical experience with shortened treatment duration is extensive, there are few studies evaluating the effectiveness and extent to which these regimens may be used.MethodsA large statewide poison center database was reviewed for all acetaminophen exposures involving potentially toxic acute and chronic ingestions, in addition to those taking place at unknown times. Patients were identified who met laboratory criteria for early N-acetylcysteine (NAC) discontinuation (APAP>10 micro/mL, INRResultsOf 3303 individuals with potentially toxic acetaminophen ingestions, 1932 met criteria for early NAC discontinuation. Mean treatment duration was 36.4+/-7.7 hours (acute=37.3+/-7.6 hours; chronic=34.8+/-7.4 hours; unknown=35.2+/-7.6 hours). The poison center database search identified no short-course eligible subjects who developed subsequent hepatotoxicity or death followingConclusionTreatment with shortened-course oral NAC in patients meeting criteria for early discontinuation may be an effective treatment option in a sizeable proportion of individuals with potentially toxic acetaminophen ingestions.

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