- Title
- N-acetylcysteine in the poisoned patient
- Creator
- Chiew, Angela L.; Isbister, Geoffrey K.
- Relation
- The Therapeutic Use of N-Acetylcysteine (NAC) in Medicine p. 147-168
- Publisher Link
- http://dx.doi.org/10.1007/978-981-10-5311-5_9
- Publisher
- Adis Singapore
- Resource Type
- book chapter
- Date
- 2019
- Description
- N-Acetylcysteine (NAC) is the mainstay of treatment for paracetamol poisoning, and its use has led to a significant reduction in both the mortality and morbidity following paracetamol overdose. NAC efficacy as a specific antidote for paracetamol poisoning relies mainly on its ability to stimulate glutathione synthesis. Furthermore, it also supplies thiol groups, which can directly bind with N-acetyl-p-benzoquinone imine in hepatocytes and enhances non-toxic sulphate conjugation. As NAC is the cornerstone of treatment in paracetamol poisoning, trials have mainly focused around optimising dose, duration, rate and route of administration, with the primary aim to decrease rates of adverse events, shorten treatment time and maintain efficacy. NAC use is not just confined to paracetamol and has been utilised for a wide variety of toxins and ingestions. These toxins range from herbicides, mushrooms, hydrocarbons and metals. NAC’s proposed mechanism of action for these toxins is as an antioxidant and/or glutathione replenishing. The evidence for its use in most other toxins is limited to animal studies, case reports and small case series, due to the uncommon occurrence of these toxin exposures. With these toxins NAC is often given in combination with other therapies, making it difficult to determine its utility for many toxins. Because of the relative safety of NAC and the high morbidity associated with many of these ingestions, NAC is often recommended.
- Subject
- paracetamol poisoning; paracetamol overdose; N-acetyl-p-benzoquione imine; drug-induced liver injury (DILI); amatoxins
- Identifier
- http://hdl.handle.net/1959.13/1453009
- Identifier
- uon:44567
- Identifier
- ISBN:9789811053108
- Language
- eng
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