Indication of n-acetylcysteine in differents forms of paracetamol
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Abstract
Introduction: paracetamol hepatotoxicity is related to the formation of the metabolite N-acetyl-parabenzoquinoneimine (NAPQI) and its lack of detoxification through glutathione, whose reserves are depleted in paracetamol overdose. The administration of N-acetylcysteine (NAC) as a donor of sulfhydryl groups (-SH) can prevent liver damage that could even occur with therapeutic or toxic doses.
Methods: 5 cases of exposure to paracetamol are discussed, in which NAC was administered due to impaired liver function. These manifestations presented different severity depending on the drug doses and the time until medical consultation.
Results: four patients ingested single toxic doses and one patient received the maximum daily dose of paracetamol of 4000 mg/day for 5 days. The patient who consulted within 4 hours after ingestion did not present elevation of transaminases. All patients received NAC, with normal liver enzymes at discharge.
Conclusion: the early administration of NAC may be useful to prevent liver damage both in toxic dose intakes and in cases of use of maximum therapeutic doses for several days.
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García García A, Cobos Rodríguez J, García Ferreira A, et al. Hepatotoxicidad aguda por paracetamol. RAPD Online. 2020;43(2):68-75.
Bunchorntavakul C, Reddy KR. Acetaminophen (APAP or N-Acetyl-p-Aminophenol) and acute liver failure. Clin Liver Dis. 2018;22(2):325-346. https://doi.org/10.1016/j.cld.2018.01.007
Tittarelli R, Pellegrini M, Scarpellini MG, et al. Hepatotoxicity of paracetamol and related fatalities. Eur Rev Med Pharmacol Sci. 2017;21(1 Suppl):95-101.
Rumack BH, Bateman DN. Acetaminophen and acetylcysteine dose and duration: past, present and future. Clin Toxicol (Phila). 2012 Feb;50(2):91-98. https://doi.org/10.3109/15563650.2012.659252. Errata en: Clin Toxicol (Phila). 2021;59(4):359. https://doi.org/10.1080/15563650.2021.1885892. Errata en: Clin Toxicol (Phila). 2021;59(12):1195. https://doi.org/10.1080/15563650.2021.1916026.
Robertson WO. Poisoning and toxicology handbook. Crit Care Med. 2003;31(5):1605.https://doi.org/10.1097/01.CCM.0000065684.88791.63.
Lewis RK, Paloucek FP. Assessment and treatment of acetaminophen overdose. Clin Pharm. 1991;10(10):765-774.
Prescott LF. Paracetamol overdosage. Pharmacological considerations and clinical management. Drugs. 1983;25(3):290-314. https://doi.org/10.2165/00003495-198325030-00002.
Makin AJ, Wendon J, Williams R. A 7-year experience of severe acetaminophen-induced hepatotoxicity (1987-1993). Gastroenterology. 1995;109(6):1907-1916. https://doi.org/10.1016/0016-5085(95)90758-0.
Wong A, Graudins A. Risk prediction of hepatotoxicity in paracetamol poisoning. Clin Toxicol (Phila). 2017;55(8):879-892. https://doi.org/10.1080/15563650.2017.1317349.
Jaeschke H. Acetaminophen: dose-dependent drug hepatotoxicity and acute liver failure in patients. Dig Dis. 2015;33(4):464-471. https://doi.org/10.1159/000374090.