Toxicology

Route

Dose

Oral

Loading dose:

140 mg/kg

Maintenance doses:

70 mg/kg every 4 hr for a total of 17 doses (72 hr)

Intravenous

Loading dose:

150 mg/kg (max 15 g)a in 200 mL of 5% dextrose in water infused for 60 min

Maintenance dose:

50 mg/kg (max 5 g)a in 500 mL of 5% dextrose in water infused for 4 hr

followed by

100 mg/kg (max 10 g)a,b in 1000 mL of 5% dextrose in water infused for 16 hr

Patients weighing < 40 kg require reduced volume administration

a Dose limits are provided by the manufacturer; however, small retrospective studies have shown that acetylcysteine is well tolerated when using actual body weight for

bHigher ongoing infusion rates (e.g., 200 mg/kg over 16 hr) may be required for massive paracetamol ingestions (i.e., initial concentration that is double the standard

nomogram line) and a clinical toxicologist should be consulted (Chiew AL, Reith D, Pomerleau A, et al. Updated guidelines for the management of paracetamol

poisoning in Australia and New Zealand. Med J Aust 2020;212:175-183. doi: 10.5694/mja2.50428).

Patients should be monitored for improvement in vital signs and mental status.

potential worsening.

ALT, aspartate aminotransferase (AST), total bilirubin, INR, and prothrombin time

Acetylcysteine may cause a dose-dependent decrease in prothrombin time, although this has no

clinical effect on coagulation

BUN and SCr

Fulminant hepatic failure: Serum bicarbonate, serum sodium, serum lactate, arterial blood gas,

serum glucose, and ammonia concentrations