Assessment of N-acetylcysteine use for acetaminophen overdose in the emergency department of a community teaching hospital: A pilot study

Assessment of N-acetylcysteine use for acetaminophen overdose in the emergency department of a community teaching hospital: A pilot study

N-acetylcysteine (NAC) is the first-line treatment for acetaminophen (APAP) overdose. However, using NAC inappropriately is associated with an increased risk of adverse effects as well as a substantial increase in hospitalization and healthcare costs. This study aims to assess NAC utilization for ac...

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Bibliographic Details
Published in:Saudi journal of anaesthesia Vol. 17; no. 2; pp. 168 - 173
Main Authors: Alaska, Yasser A, Alghadeer, Sultan M, Alrabiah, Abdulaziz A, Harb, Abdulaziz, Almadi, Bana
Format: Journal Article
Language:English
Published: India Medknow Publications and Media Pvt. Ltd 01-04-2023
Medknow Publications & Media Pvt. Ltd
Wolters Kluwer - Medknow
Wolters Kluwer Medknow Publications
Subjects:
Acetaminophen
Acetylcysteine
Analgesics
Drugs
emergency
Emergency medical care
Emergency service
Evidence-based medicine
Hospitals
Medical care, Cost of
n-acetylcysteine
Original
Overdose
protocol
Teaching hospitals
Saudi Arabia
overdose
emergency
protocol
Acetaminophen
N-acetylcysteine
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Summary:N-acetylcysteine (NAC) is the first-line treatment for acetaminophen (APAP) overdose. However, using NAC inappropriately is associated with an increased risk of adverse effects as well as a substantial increase in hospitalization and healthcare costs. This study aims to assess NAC utilization for acute APAP overdose in the emergency department of a community teaching hospital in Saudi Arabia. A retrospective chart review in which the patients initiated on an NAC secondary to acute APAP overdose at KSUMC during the period of June 2015 till November 2018 were included and assessed based on developed validated evident-based protocol for administering NAC for acute APAP ingestion. A total of 29 patients received NAC treatment for acute APAP overdose; 15 of which were adults, and 14 were pediatrics. Appropriate prescribing of NAC was observed in 14 (48.28%) patients, whereas NAC was inappropriately indicated for 15 (51.72%) patients; 9 of them were adults and 6 patients were pediatric. APAP-Ingestion <150 mg/kg (<200 mg/kg in children) was the most common reason for inappropriate use (n = 7, 46.67%) followed by administering NAC <4 hours post-APAP ingestion (n = 4, 26.67%). Improper NAC administration appears to be a significant issue among patients with APAP overdose. The utilization of a protocol for the management of APAP overdose will reduce the unnecessary usage of NAC.
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ISSN:1658-354X
0975-3125
DOI:10.4103/sja.sja_707_22