title: Anaphylactoid reaction to intravenous acetylcysteine associated with electrocardiographic abnormalities.
abstract: OBJECTIVE
  To review the potential for anaphylactoid reactions to intravenously administered acetylcysteine when used in the treatment of acetaminophen overdose. This case is unique in that electrocardiographic changes, including ST segment depression and T-wave inversion were associated with the episode and complicated the diagnosis.
  
  
  METHODS
  Reference articles and letters are identified in the text.
  
  
  RESULTS
  Intravenous administration of acetylcysteine has been used in the treatment of acetaminophen overdose. This route may be considered in some clinical situations where oral therapy is complicated. Anaphylactoid reactions, including cutaneous eruptions, flushing, chest pain, tachycardia, and fever have been reported in up to three percent of patients receiving intravenous acetylcysteine. The nature of these reactions and evidence concerning their etiology suggest a histamine-release phenomenon. Response to intervention with antihistamines and the safety of further acetylcysteine administration are discussed.
  
  
  CONCLUSIONS
  This case illustrates a variant anaphylactoid reaction to intravenously administered acetylcysteine and emphasizes the need for practitioners to consider the potential for these reactions prior to initiation of therapy and indicates appropriate treatment of these reactions.
authors.affiliation: Ohio Northern University, Ada.
authors.forename: M F
authors.initials: MF
authors.lastname: Bonfiglio
authors.forename: S M
authors.initials: SM
authors.lastname: Traeger
authors.forename: D T
authors.initials: DT
authors.lastname: Hulisz
authors.forename: B R
authors.initials: BR
authors.lastname: Martin
mesh_terms: D000082:Acetaminophen / Q000506:poisoning; D000111:Acetylcysteine / Q000008:administration & dosage / Q000009:adverse effects*; D000328:Adult; D000707:Anaphylaxis / Q000139:chemically induced* / Q000175:diagnosis / Q000503:physiopathology; D062787:Drug Overdose; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous / Q000009:adverse effects
chemical_list: D000082:Acetaminophen; D000111:Acetylcysteine