Is there a better way to administer IV N-acetylcysteine?

3 out of 5 stars Fewer adverse effects with a modified two-bag acetylcysteine protocol in paracetamol overdose. McNulty R et al. Clin Toxicol 2017 Dec 8 [Epub ahead of print] Abstract Current recommendations for dosing intravenous N-acetylcysteine (Acetadote) for treating acute acetaminophen (paracetamol) poisoning involves a somewhat complex three-bag protocol, using 3 direct concentrations of the antidote given over a 21-hour period. Unfortunately, this protocol results in a high incidence of (usually mild) adverse events, including cutaneous effects, nausea and vomiting, and anaphylactoid reactions. Severe reactions such as hypotension and bronchospasm occur but are unusual. In addition, the three-bag protocol has been shown to result in medication errors in up to one-third of patients. As the Missouri Poison Center points out in an excellent post: The FDA-approved 21-hour, three-bag protocol for Acetadote administration is effective; however, there is substantial risk for dosing and administration errors because the regimen involves preparing three bags of differing concentrations derived from weight-based doses and dilutions, each with a different length of infusion. Mistakes may occur due to inaccurate dose calculation and IV admixture preparation, incorrect rate of administration, interruptions in therapy associated with changing bags or adverse effects (i.e., anaphylactoid reactions and dose-related vomiting), and unnecessary administration. In February 2015...
Source: The Poison Review - Category: Toxicology Authors: Tags: Medical Acetadote acetaminophen antidote N-acetylcysteine paracetamol three-bag protocol toxicity two-bag protocol Source Type: news

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Authors: Sabet Sarvestani F, Azarpira N Abstract Heart and cerebral infarctions, as two important ischemic diseases, lead to the death of tissues due to inadequate blood supply and high mortality worldwide. These statuses are started via blockage of vessels and depletion of oxygen and nutrients which affected these areas. After reperfusion and restoration of oxygen supply, more severe injury was mediated by multifaceted cascades of inflammation and oxidative stress. microRNAs (miRNAs) as the regulator of biological and pathological pathways can adjust these conditions by interaction with their targets. Also, miRNAs...
Source: Immunological Investigations - Category: Allergy & Immunology Tags: Immunol Invest Source Type: research
CONCLUSION: We demonstrate that, compared to N-acetylcysteine alone, co-administration of glycyrrhizin decreases the liver necrosis score and improves survival in a murine model of acetaminophen-induced liver injury. Our study opens a potential new therapeutic pathway in the prevention of acetaminophen hepatotoxicity. PMID: 33033567 [PubMed]
Source: World Journal of Hepatology - Category: Gastroenterology Tags: World J Hepatol Source Type: research
Authors: Kim MS, Lee K, Ku JM, Choi YJ, Mok K, Kim D, Cheon C, Ko SG Abstract Pancreatic cancer has a poor prognosis with a five-year survival rate of less than 10%. Moreover, chemotherapy is mostly rendered ineffective owing to chemotherapy resistance and cytotoxicity. Therefore, the development of effective therapeutic strategies and novel drugs against pancreatic cancer is an urgent need. Cucurbitacin D (CuD), a plant steroid derived from Trichosanthes kirilowii, is an anticancer agent effective against various cancer cell lines. However, the anticancer activity and molecular mechanism of CuD in pancreatic cance...
Source: Evidence-based Complementary and Alternative Medicine - Category: Complementary Medicine Tags: Evid Based Complement Alternat Med Source Type: research
Conclusions: Pediatric patients have been overprescribed opioids after operative treatment of supracondylar humerus fractures at our institution. Families who report pain scores>5 of 10 and/or persistent opioid use beyond postoperative day 5 warrant further clinical evaluation. Two of 3 pain outliers in this study experienced a minor postoperative complication. With appropriate parental counseling, satisfactory pain control can likely be achieved with acetaminophen and ibuprofen for most patients. If oxycodone is prescribed for breakthrough pain, then the authors recommend limiting to
Source: Journal of Pediatric Orthopaedics - Category: Orthopaedics Tags: Trauma Upper Extremity Source Type: research
AbstractThe role of drug-coated balloons (DCBs) in patients with acute myocardial infarction (AMI) remains controversial. We performed a meta-analysis of all published studies comparing the outcomes of DCBs vs. stenting in AMI patients. Four studies with 497 patients (534 lesions) were included (three randomized controlled trials and one observational study). During a mean follow-up of 9  months (range 6–12 months), DCBs were associated with similar risk of major adverse cardiovascular events (5% vs. 4.4%; OR 1.24, 95% CI: [0.34, 4.51],p = 0.74,I2 = 35%), all-cause mortality (0.0...
Source: Cardiovascular Intervention and Therapeutics - Category: Cardiology Source Type: research
The association between implanted stent types and heart failure in patients with non –ST-elevation myocardial infarction (NSTEMI) remains unknown. The current study aimed to investigate whether the implantation of a newer-generation drug-eluting stent (NG-DES) compared with that of a bare-metal stent (BMS) in patients with NSTEMI who receive an undefined duration of dual antiplate let therapy (DAPT) reduces the risk of hospitalization for heart failure (HHF).
Source: Atherosclerosis - Category: Cardiology Authors: Source Type: research
This study aims to analyze the splicing characteristics of dystrophin PEs and compare them with those of dystrophin canonical exons (CEs). Forty-two reported dystrophin PEs were divided into a splice site (ss) group and a splicing regulatory element (SRE) group. Five dystrophin PEs with characteristics of poison exons were identified and categorized as the possible poison exon group. The comparative analysis of each essential splicing signal among different groups of dystrophin PEs and dystrophin CEs revealed that the possible poison exon group had a stronger 3′ ss compared to any other group. As for auxiliary SR...
Source: Genes - Category: Genetics & Stem Cells Authors: Tags: Article Source Type: research
We describe an autopsy case of fatal poisoning due to accidental overdose of pilsicainide, which is a Vaughan Williams class IC antiarrhythmic drug (a pure sodium channel blocker). A man in his 50s was found dead in his home at approximately noon. He had ischemic heart disease and insomnia, and had previously demonstrated improper prescription drug adherence. The autopsy revealed old coronary artery bypass grafting and mild fibrosis of myocardium, but no acute myocardial infarction was found in microscopic examination. Toxicological analysis also identified a high blood concentration of pilsicainide (femoral vein blood, 14...
Source: The American Journal of Forensic Medicine and Pathology - Category: Forensic Medicine Tags: Case Reports Source Type: research
Conclusion The doctors gave my daughter drugs they knew would cause her kidneys to stop working. They gave her these drugs in spite of both of us telling them on a day-to-day basis not to give them. The hospital covered it up. The hospital refused to give us the incident report. The hospital refused to give us a copy of the notes from the meeting with the ethics committee. The hospital denied my daughter’s right to make her own decisions. The hospital tried to deny me from being my daughter's advocate. The hospital administrator threatened to charge me with practicing medicine without a license. The CEO refused to ta...
Source: vactruth.com - Category: Allergy & Immunology Authors: Tags: Case Reports on Vaccine Injury Human Jim O'Kelly Top Stories truth about vaccines Vaccine Death Source Type: blogs
3.5 out of 5 stars The Effectivenss and Risks of Long-Term Opioid Therapy for Chronic Pain: A Systematic Review for a National Institutes of Health Pathways to Prevention Workshop. Chou R et al.  Ann Intern Med 2015 Jan 13 [Epub ahead of print] Abstract Although prescription opioids have been advocated and used for long-term treatment of chronic non-cancer pain, there is scant literature supporting such use. Most studies have been limited to a time period of 3 months or less. The purpose of this literature review was to assess the evidence pertaining to safety and effectiveness of long-term (> 1 year) opioid therap...
Source: The Poison Review - Category: Toxicology Authors: Tags: Medical chronic pain long-term opioids prescription analgesics Source Type: news
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