title: Acetylcysteine for acetaminophen overdose in patients who weigh >100 kg.
abstract: N-Acetylcysteine (NAC) dosing for acetaminophen (APAP) overdose is weight based (150 mg/kg intravenous or 140-mg/kg oral loading dose) and, in the United States, the dosing protocol recommends using a maximum patient weight of 100 and 110 kg, respectively. Little clinical data describe the use of NAC for APAP poisoning in patients weighing >100 kg. The aim of this study was to describe the demographics, outcomes, and adverse event (AE) rates of patients weighing >100 kg treated with oral or IV NAC for APAP poisoning. Patients were identified from a multicenter retrospective NAC safety study for APAP overdose. We included patients with a recorded weight. Trained chart abstractors used a standardized form. Selected data included age, gender, weight, serum alanine transaminase, and aspartate transaminases, coingestants, NAC administration route, ingestion type, AEs, and outcome [hepatotoxicity (alanine transaminase > 1000 U/L), liver transplant, or death]. Descriptive statistics were used. Of 503 study patients, 37 (7.4%) had recorded weights >100 kg. The median (range) weight was 110 kg (101-160). The median (range) dosing for patients treated with oral NAC was 140 mg/kg (127-143 mg/kg) and 150 (108-168) mg/kg for IV NAC. Hepatotoxicity occurred in 12/36 (33.3%) patients. Death occurred in 4/36 (11.1%) patients. Thirteen NAC-related AEs occurred in 8 patients (1.6 per person). All AEs were related to NAC and were rated nonserious by the reviewer. Clinicians use an actual weight-based NAC dose rather than a maximum weight cutoff dose. Hepatotoxicity was common in our cohort. AEs were relatively common but not serious.
authors.affiliation: 1Department of Emergency Medicine, Wilford Hall Medical Center, Lackland AFB, TX 2Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, CO 3Department of Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, CO.
authors.forename: Shawn M
authors.initials: SM
authors.lastname: Varney
authors.forename: Jennie A
authors.initials: JA
authors.lastname: Buchanan
authors.forename: Jamie
authors.initials: J
authors.lastname: Kokko
authors.forename: Kennon
authors.initials: K
authors.lastname: Heard
mesh_terms: D000082:Acetaminophen / Q000506:poisoning*; D000111:Acetylcysteine / Q000008:administration & dosage* / Q000009:adverse effects; D061605:Administration, Intravenous; D000284:Administration, Oral; D000328:Adult; D000931:Antidotes / Q000008:administration & dosage* / Q000009:adverse effects; D001835:Body Weight; D056486:Chemical and Drug Induced Liver Injury / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D004305:Dose-Response Relationship, Drug; D062787:Drug Overdose; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D000931:Antidotes; D000082:Acetaminophen; D000111:Acetylcysteine