Acetylcysteine is used in the treatment of: (LQ)
|C||Carbon tetrachloride toxicity|
|D||All of the above|
a. Acetylcysteine is indicated in the treatment of acetaminophen (paracetamol) overdose to protect against hepatotoxicity.
b. Acetaminophen (paracetamol) toxicity is a common cause of drug-induced hepatotoxicity in children and adults. N-acetylcysteine (NAC) is the antidote of choice in treating acetaminophen-induced hepatotoxicity.
c. An important factor in assessing the efficacy of NAC is the timing of therapy initiation in relation to the ingestion.
d. Patients that ingest an acute overdose and have NAC therapy initiated within 8 hours do well and have less than a 10% incidence of hepatotoxicity and generally do not develop liver failure or die.
e. Those patients that chronically ingest excessive doses of acetaminophen over many hours and/or have NAC therapy initiated more than 8 hours after an acute overdose have an approximately 8-50% incidence of hepatotoxicity. Unlike clinical scenarios in which NAC therapy is initiated early, patients that have administration delayed are at risk of developing fulminant hepatic failure and death.
f. The antidotal efficacy of NAC is determined by great extent to the time that treatment is initiated after an overdose of acetaminophen. NAC therapy should be initiated within 8 hours of an acute ingestion and otherwise as soon as possible.
g. While many protocols have defined lengths of treatment, it is generally recommended that NAC be administered until the serum acetaminophen concentration is undetectable (<10 mcg/ml) and the patient is clinically well with normal liver function tests. In cases of hepatotoxicity, NAC should be continued until: 1) the serum liver transaminases fall to less than 1000 IU/L, bilirubin and coagulation studies are normal, and the patient is clinically well; 2) the patient receives a liver transplant; or 3) the patient dies.