Emergency Medicine Book

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N-Acetylcysteine

Aka: N-Acetylcysteine, Acetadote, Mucomyst
  1. Indications: Established
    1. Acetaminophen Overdose
    2. Contrast-Induced Nephropathy prevention
  2. Indications: Evolving
    1. Prevention of COPD Exacerbation
      1. Dose: 600-1200 mg/day in divided dosing
      2. Decramer (2005) Lancet 365(9470):1552-60
    2. Idiopathic Pulmonary Fibrosis
      1. Dose: 1800 mg/day in divided dosing
      2. Demedts (2005) N Engl J Med 353(21):2229-42
  3. Mechanism
    1. N-Acetylcysteine increases glutathione levels
      1. Acts as detoxification agent
      2. Acts as antioxidant
    2. N-Acetylcysteine increases nitric oxide concentrations
      1. Stimulates vasodilation
  4. Adverse Effects (uncommon at doses 1200 mg/day or less)
    1. Nausea
    2. Vomiting
    3. Diarrhea
  5. Dosing: Acetaminophen Overdose
    1. As directed by Rumack-Matthew Acetaminophen nomogram
      1. http://www.ars-informatica.ca/toxicity_nomogram.php?calc=acetamin
    2. Adults
      1. Oral
        1. Load: 140 mg/kg orally for 1 dose
        2. Next 70 mg/kg every 4 hours for total of 17 doses
      2. IV
        1. Load: 150 mg/kg IV for 1 dose
        2. Next: 12.5 mg/kg/hour for 4 hours
        3. Next: 6.25 mg/kg/hour for 16 hours
    3. Child
      1. Oral: Same as for adults
      2. IV: Same as for adults EXCEPT for <88 lb (40 kg), dilute to 40 mg/ml in D5W
        1. Smaller volume to prevent Hyponatremia
  6. References
    1. Rowden (2006) Clin Lab Med 26(1): 49-65
    2. Sung (1997) Pediatrics 100(3 pt 1): 389-91

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