title: Oral and Intravenous Acetylcysteine for Treatment of Acetaminophen Toxicity: A Systematic Review and Meta-analysis.
abstract: BACKGROUND
  There are few reports summarizing the effectiveness of oral and intravenous (IV) acetylcysteine. We determined the proportion of acetaminophen poisoned patients who develop hepatotoxicity (serum transaminase > 1000 IU/L) when treated with oral and IV acetylcysteine.
  
  
  METHODS
  Studies were double abstracted by trained researchers. We determined the proportions of patients who developed hepatotoxicity for each route using a random effects model. Studies were further stratified by early and late treatment.
  
  
  RESULTS
  We screened 4,416 abstracts; 16 articles, including 5,164 patients, were included in the meta-analysis. The overall rate of hepatotoxicity for the oral and IV routes were 12.6% and 13.2%, respectively. Treatment delays are associated with a higher rate of hepatotoxicity.
  
  
  CONCLUSIONS
  Studies report similar rates of hepatotoxicity for oral and IV acetylcysteine, but direct comparisons are lacking. While it is difficult to disentangle the effects of dose and duration from route, our findings suggest that the rates of hepatotoxicity are similar for oral and IV administration.
authors.affiliation: Rocky Mountain Poison and Drug Center, Denver Health Medical Center, University of Colorado, Denver, Colorado ; Vanderbilt University School of Nursing, Nashville, Tennessee.
authors.forename: Jody L
authors.initials: JL
authors.lastname: Green
authors.forename: Kennon J
authors.initials: KJ
authors.lastname: Heard
authors.forename: Kate M
authors.initials: KM
authors.lastname: Reynolds
authors.forename: Donald
authors.initials: D
authors.lastname: Albert