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Acetylcysteine

Grade

Paracetamol Poisoning


Technique

  • Initial Treatment: 140-280 mg/kg as 5% solution in 5% dextrose as a slow IV infusion after gastric lavage, or 280 mg/kg PO (via gastric tube). Parenteral administration is preferred in serious intoxication or vomiting patients. Significant overdoses may require up to 17 doses (Baumann et al., 2008; Hendrickson, 2019; Lee, 2013; MacNaughton, 2003; Nielsen et al., 2007; Piperno et al., 1978; Savides and Oehme, 1983; St Omer and Mohammad, 1984; Tams, 1984; Villar et al., 1998).

  • Subsequent Treatment: 70 mg/kg, slow IV infusions, q6h,  for up to 7 additional doses ( 2 days) depending upon the level of toxicity exposure 

  • Additional Medications: Consider intravenous fluids, N-acetylcysteine, ascorbic acid, and sodium bicarbonate.

Formulations

  • Solutions: [Injectable/Nebulisation]: 100 mg/ml solution and 200 mg/ml solution.

  • Topical [Ocular]: 5% ophthalmic solution in combination with 0.35% hypromellose ophthalmic drops in a 10 ml bottle.


Therapeutics

Therapeutics

Evidence

Evidence Base

  1. Baumann, J., Ghosh, S., Szakmany, T., Jancso, G., Ferencz, A., Roth, E., Bogar, L., 2008. Short-term effects of N-acetylcysteine and ischemic preconditioning in a canine model of hepatic ischemia-reperfusion injury. Eur Surg Res 41, 226–230. https://doi.org/10.1159/000135707

  2. Hendrickson, R.G., 2019. What is the most appropriate dose of N-acetylcysteine after massive acetaminophen overdose? Clinical Toxicology 57, 686–691. https://doi.org/10.1080/15563650.2019.1579914

  3. Lee, J.A., 2013. Emergency Management and Treatment of the Poisoned Small Animal Patient. Veterinary Clinics of North America: Small Animal Practice, Emergency Medicine 43, 757–771. https://doi.org/10.1016/j.cvsm.2013.03.010

  4. MacNaughton, S.M., 2003. Acetaminophen toxicosis in a Dalmatian. Can Vet J 44, 142–144.

  5. Nielsen, L., Shaw, M., Morris, J., 2007. What is your diagnosis? Paracetamol poisoning. J Small Anim Pract 48, 121–124. https://doi.org/10.1111/j.1748-5827.2006.00145.x

  6. Piperno, E., Mosher, A.H., Berssenbruegge, D.A., Winkler, J.D., Smith, R.B., 1978. Pathophysiology of acetaminophen overdosage toxicity: implications for management. Pediatrics 62, 880–889.

  7. Savides, M.C., Oehme, F.W., 1983. Acetaminophen and its toxicity. J Appl Toxicol 3, 96–111. https://doi.org/10.1002/jat.2550030209

  8. St Omer, V.E., Mohammad, F.K., 1984. Effect of antidotal N-acetylcysteine on the pharmacokinetics of acetaminophen in dogs. J Vet Pharmacol Ther 7, 277–281. https://doi.org/10.1111/j.1365-2885.1984.tb00912.x

  9. Tams, T.R., 1984. Management of liver disease in dogs and cats. Mod Vet Pract 65, 107–114.

  10. Villar, D., Buck, W.B., Gonzalez, J.M., 1998. Ibuprofen, aspirin and acetaminophen toxicosis and treatment in dogs and cats. Vet Hum Toxicol 40, 156–162.

Other Intoxications/Oxidative Stress 

  1. Gwaltney-Brant, S.M., Rumbeiha, W.K., 2002. Newer antidotal therapies. Veterinary Clinics of North America: Small Animal Practice 32, 323–339. https://doi.org/10.1016/S0195-5616(01)00008-0

  2. Lasarewa, D.N., 1960. [Reaction of the cardiovascular system of the sensitized dog and rabbit to adrenaline and carbocholine]. Allerg Asthma (Leipz) 6, 42–52.

  3. Murphy, L.A., Coleman, A.E., 2012. Xylitol Toxicosis in Dogs. Veterinary Clinics of North America: Small Animal Practice, Common Toxicologic Issues in Small Animals 42, 307–312. https://doi.org/10.1016/j.cvsm.2011.12.003

  4. Murphy, L.A., Dunayer, E.K., 2018. Xylitol Toxicosis in Dogs: An Update. Veterinary Clinics of North America: Small Animal Practice, Common Toxicologic Issues in Small Animals: An Update 48, 985–990. https://doi.org/10.1016/j.cvsm.2018.06.004

  5. Puschner, B., Wegenast, C., 2012. Mushroom Poisoning Cases in Dogs and Cats: Diagnosis and Treatment of Hepatotoxic, Neurotoxic, Gastroenterotoxic, Nephrotoxic, and Muscarinic Mushrooms. Veterinary Clinics of North America: Small Animal Practice, Common Toxicologic Issues in Small Animals 42, 375–387. https://doi.org/10.1016/j.cvsm.2011.12.002

  6. Tams, T.R., 1984. Management of liver disease in dogs and cats. Mod Vet Pract 65, 107–114.

  7. Webb, C., Twedt, D., 2008. Oxidative Stress and Liver Disease. Veterinary Clinics of North America: Small Animal Practice, Oxidative Stress: The Role of Mitochondria, Free Radicals, and Antioxidants 38, 125–135. https://doi.org/10.1016/j.cvsm.2007.10.001

  8. Webster, C.R.L., Cooper, J., 2009. Therapeutic Use of Cytoprotective Agents in Canine and Feline Hepatobiliary Disease. Veterinary Clinics of North America: Small Animal Practice, Hepatology 39, 631–652. https://doi.org/10.1016/j.cvsm.2009.02.002

  9. Wray, J.D., 2008. Methaemoglobinaemia caused by hydroxycarbamide (hydroxyurea) ingestion in a dog. J Small Anim Pract 49, 211–215. https://doi.org/10.1111/j.1748-5827.2007.00449.x

Expert Opinion

  1. 1317822  Extrapolation of pharmacological properties in man and veterinary species. Some material employed in collating the data displayed here was taken from veterinary product datasheets or extrapolated from pharmacology texts.


Monograph Details

Monograph Details

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