200 mg/ml solution in a 10 ml ampoule (20 % solution)
The paracetamol poisoning causes oxidative stress and inflammation which consequently causes a depletion in the glutathione (anti-oxidant) reserves.
NAC is most beneficial if administered within 8 hours of ingestion. after that, its benefits decline.
In accordance with National Poison Information Service (NPIS), previous anaphylactoid reactions to NAC is not an absolute contraindication. The latter can be pre-treated with anti-histamines: IV Chlorpheniramine 10 mg.
Treatment of Paracetamol Poisoning via IV:
- 150 mg/kg given in 200 ml of infusion fluid over 15 minutes.
- 50 mg/kg in 500 ml infusion fluid over the next 4 hours.
- 100 mg/kg in 1 L infusion over the next 16 hours.
The prepared infusion should be clear, colourless and free from any particulate matter and discolouration before administration.
Table 1: Properties of NAC
Technical information
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Incompatible with
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Rubber and metals
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Compatible with
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Plastic, glass, stainless steel
Flush: NaCL 0.9 %
Solutions: Glucose 5 % (preferable), NaCL 0.9 %
*Solutions should include additional KCL.
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pH
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6.0 – 7.5
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Storage
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Below 250C
Any changes in color of solution to that of light purple
is not significant. May still be used.
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Stability
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Prepared solutions should be used immediately if possible;
otherwise may be kept for 24 h
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Monitoring Parameters
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Measures
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Rationale
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Liver Function & INR
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Increased transaminases: hepatotoxicity.
NAC may increase INR.
INR ≤ 1.3, normal transaminases: discontinue treatment.
Transaminases
& INR raised: repeat third infusion over 16 h.
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ECG
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May be changes
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Renal function & Serum K
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Renal failure may be present as a complication.
Low K+ may be present.
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Sodium Bicarbonate
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To avoid metabolic acidosis complications.
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Other Information
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Infusion
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Rapid infusions may facilitate higher chances of
hypersensitivity reactions.
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KIV antihistamines and corticosteroids.
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Overdose
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Anaphylactoid reactions, Hepatic encephalopathy
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KIV vitals
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Treating patients under restriction of fluid (ROF):
Range of dilutions in 100 - 250 ml of Glucose 5 % .
Some centres used undiluted infusions (10 g in 50 ml).
Use central line for undiluted solutions.
References:
1. http://www.pharmpress.com/files/docs/Injectable%20Drugs%20sample.pdf
2. http://www.ukcpa.org.uk/ukcpadocuments/9.pdf
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