Factors impacting hospital length of stay (LOS) were of particular interest. The objective of this study was to examine the management of patients admitted for treatment of APAP overdose. Clin Toxicol 2008 46: 921.Acetaminophen (APAP) overdose is the most common pharmaceutical poisoning. Cardiac arrest following therapeutic administration of N-acetylcysteine for paracetamol overdose. Status epilepticus after a massive intrave-nous N-acetylcysteine overdose leading to intracranial hypertension and death. Adverse reactions associated with acetylcysteine. Hemolysis and hemolytic uremic syndrome following five-fold N-acetylcysteine overdose. Random and systematic medication errors in routine clinical practice: a multicentre study of infusions, using acetylcysteine as an example. Ferner RE, Langford NJ, Anton C, Hutchings A, Bateman, DN, Routledge, PA.Despite this, the patient did not experience any significant adverse effects, survived this hospital admission, and was discharged home. 2–5 The patient's laboratory results did demonstrate evidence of hemolysis, which might have been secondary to hepatic injury or acetylcysteine toxicity. 1 The effects of acetylcysteine overdose have been reported in several instances and include hemolysis, cerebral edema, status epilepticus, and death. However, given its complicated dosing regimen, it has a high potential for medication-related errors. Her liver function test results continued to improve and 4 days after transfer to a tertiary care facility, her AST and ALT levels were 139 and 1,349 IU/L and her INR was 1.2.Īcetylcysteine is the established antidote for acetaminophen overdose. While the patient was given 10 times the recommended dose of acetylcysteine, the total dose administered was over 8 times the approved dosage since the patient only received the infusion for 14 h. Her INR trended downward but remained elevated at 2.0 she did not meet any King's College Criteria, given her normal arterial serum pH, INR < 6.5, creatinine level < 3.4 mg/dL, and no evidence of encephalopathy.

Her laboratory results revealed evidence of hemolysis with a total bilirubin level of 6.4 mg/dL and an indirect bilirubin level of 2.9 mg/dL however, her hemoglobin level remained stable. The patient was monitored closely, but did not exhibit any significant signs or symptoms of acetylcysteine overdose although her nausea and vomiting, that had been present since her admission, persisted. It was determined that the patient received over 14 h of the infusion for a total dose of approximately 38,400 mg. Upon nursing shift change, it was noted that the patient's weight was incorrectly entered into the computer this prompted the immediate discontinuation of the infusion. A data-entry error resulted in her weight being entered as 439.0 kg instead of 43.9 kg requiring an infusion containing 42,390 mg of acetylcysteine. The admitting team discussed the case with Poison Control who recommended administering acetylcysteine IV 100 mg/kg over 16 h since the patient had already received the 150 mg/kg loading dose and 50 mg/kg 2nd dose.

At the time of admission, she had an acetylcysteine infusion of 67 mL/hr without documentation of the dose or concentration. Upon arrival, her aspartate transaminase (AST) and alanine transaminase (ALT) levels were 9,388 and 7,472 IU/L, international normalized ratio (INR) was 4.1, and lactate level was 3.4 mmol/L. Over the next 2 days, her transaminase levels rose dramatically and her synthetic function rapidly declined she was then transferred to a tertiary care facility for a liver transplant evaluation. At 4 pm, her serum acetaminophen concentration was 24.2 mcg/mL, raising concern that she had ingested more than the reported dose. She presented to an outside hospital at 10 am with complaints of epigastric pain, nausea, and vomiting, and was started on an acetylcysteine infusion in the emergency department. In 2010, a 20-year-old black woman ingested ten 500-mg acetaminophen tablets in a reported suicide attempt at 4 am. Acetylcysteine is the established antidote for acetaminophen toxicity however, its overdose is associated with several adverse effects.

Antidote for tylenol overdose mucomyst