Here we report a rare case of iatrogenic NAC overdose due to an error made during preparation of the solution. 6– 8 Due to the complexity of preparation of NAC as well as its side effects, mistakes are possible. However, despite its efficacy in reducing mortality due to acetaminophen poisoning, intravenous NAC can cause anaphylactoid reactions. 7– 9 NAC solution has been used for over two decades in emergency wards in Iran. 4– 6 Their NAC regimen was 150 mg/kg body weight given over 15–30 minutes, 50 mg/kg over 4 hours, and 100 mg/kg over 16 hours, with the final dose of 100 mg/kg repeated three times until liver aminotransferase levels reverted to normal. 1– 3 Previous studies reported that a sterile 20% solution of N-acetylcysteine (NAC) administered intravenously was effective in the treatment of acetaminophen overdose.
However, acetaminophen overdose is common in patients who present to hospital emergency rooms, and in many cases causes liver and renal necrosis. Keywords: N-acetylcysteine, overdose, acetaminophen poisoning, medication errorĪcetaminophen is a widely used analgesic and antipyretic agent. Considering the similarity between some of the clinical symptoms of acetaminophen overdose and NAC overdose, it is vitally important for the administration phases and checking of the patient's symptoms to be carried out attentively and cautiously. An excessive dosage of NAC over a short period of time can lead to hemolysis, thrombocytopenia, and acute renal failure in patients with normal glucose-6-phosphate dehydrogenase, and finally to death. She had normal arterial blood gas and vital signs. A 23-year-old alert female patient weighing 65 kg presented to the emergency ward with weakness, lethargy, extreme fatigue, nausea, and dizziness. Laboratory results and are presented and examined.
Here we report a rare case of iatrogenic NAC overdose following an error in preparation of the solution, and describe its clinical symptoms.
Ghafar Ali Mahmoudi, 1 Peyman Astaraki, 1 Azita Zafar Mohtashami, 1 Maryam Ahadi 2ġFaculty of Medicine, Department of Internal Medicine, Lorestan University of Medical Sciences, 2Legal Medicine Research Center of Lorestan, Khorramabad, IranĪbstract: N-acetylcysteine (NAC) is used widely and effectively in oral and intravenous forms as a specific antidote for acetaminophen poisoning.
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