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Paper Information

Title: 

ADVERSE EFFECTS OF INTRAVENOUS N-ACETYLCYSTEINE TRATMENT IN PATIENTS WITH ACETAMINOPHEN POISONING

Type: SPEECH
Author(s): SANAEIZADEH H.,JALALI N.,TAGHADOSINEZHAD F.A.D.
 
 
 
Name of Seminar: IRANIAN CONGRESS OF TOXICOLOGY
Type of Seminar:  CONGRESS
Sponsor:  SOCIETY OF TOXICOLOGY
Date:  2004Volume 8
 
 
Abstract: 

Various kinds of drugs have been evaluated as an acetaminophen antidote; the most important of them is N-acetylcysteine (NAC). The optimal route, dose and duration of administration for NAC in the management of acetaminophen poisoning is controversial. Various anecdotal reports have claimed development of adverse events following intravenous NAC therapy that have restricted this form of usage. In Iran, it is unclear whether the use of intravenous NAC is associated with a significant incidence of adverse events. To investigate the frequency of adverse effects of intravenous NAC therapy, to compare them with previous reports, and to asses the safety of intravenous NAC therapy, we attempted to conduct this survey.
This was a descriptive and prospective study, and was conducted at Loghman-Hakim Hospital in Tehran, Iran during a 1-year period (1380). We included all adult patients who had a history of one toxic dose (7.5gr or more) of acetaminophen intake and presenting fewer than 12 hours after consumption. These patients were treated regardless of the serum levels of acetaminophen. Patients with concurrent intoxication, coma and hepatic encephalopathy were excluded from the study. Treatment of these patients was carried out using 20-hour therapeutic protocol. There was a structured data collection form was submitted to all patients prospectively. A logistic regression analysis (based on the stepwise variable selection method was carried out, with the adverse reactions as the dependent variable, and age, sex, asthma, and medical allergy as the independent variable.
Intravenous NAC was administrated to 206 adult cases. Adverse reactions to NAC were observed in 23.3% of patients. In none of the symptomatic poisoned individuals, we had to completely stop the IV NAC infusion. No patients developed any serious adverse effects requiring intensive care and there were no deaths. It was shown that there were not significant relationships between age, sex, asthma or medical allergy and side effects.
On the basis of our findings, we concluded that the low rate of hepatotoxicity would be expected to correspond with a high frequency of adverse effects. Despite the high frequency of the adverse effects, they were transient, not life threatening, easily treated, and all patients received a complete course of intravenous NAC. Therefore, the treatment can be considered relatively safe.

 
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