Antiemetic use in acetaminophen poisoning: how does the route of N-acetylcysteine administration affect utilization?
BACKGROUND
We sought to compare antiemetic use after acetaminophen poisoning in patients treated with oral or intravenous (IV) N-acetylcysteine (NAC).


METHODS
Our retrospective chart review identified 20 orally treated patients and 17 IV-treated patients. For both groups, we calculated the total number of antiemetic doses given, their associated cost, and also determined parameters that correlated with antiemetic use.


RESULTS
IV-treated patients received fewer total antiemetic doses than those receiving oral NAC (1.1 0.2 vs. 2.8 0.7; P 0.04). Antiemetic cost correlated with doses received for both groups; however, because the regression lines differed (P 0.02), antiemetic therapy cost was less in IV-treated patients. In addition, serum acetaminophen concentration correlated with total antiemetic doses in oral NAC patients (P 0.002) but not with IV treatment patients (P 0.78).


CONCLUSIONS
Intravenous NAC reduced antiemetic utilization, and it costs less than oral therapy. Furthermore, antiemetic use appeared to be determined by a combination of acetaminophen concentration and NAC administration route.
Miller
Melissa A
MA
Department of Pharmacy, UMass Memorial Medical Center, MA, USA.
Navarro
Marisela
M
Bird
Steven B
SB
Donovan
Jennifer L
JL
D000082:Acetaminophen / Q000506:poisoning*; D000111:Acetylcysteine / Q000008:administration & dosage*; D000284:Administration, Oral; D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000506:poisoning*; D000931:Antidotes / Q000008:administration & dosage*; D000932:Antiemetics / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D004305:Dose-Response Relationship, Drug; D004333:Drug Administration Routes; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007275:Injections, Intravenous / Q000191:economics; D008297:Male; D008787:Metoclopramide / Q000627:therapeutic use; D017294:Ondansetron / Q000627:therapeutic use; D011041:Poisoning / Q000188:drug therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
D018712:Analgesics, Non-Narcotic; D000931:Antidotes; D000932:Antiemetics; D000082:Acetaminophen; D017294:Ondansetron; D008787:Metoclopramide; D000111:Acetylcysteine