Soda/Juice: 2 mL/kg (2 mL X 70 kg = 140 mL) Maintenance doses: 70 mg/kg every 4 hours for five doses.Īcetylcysteine 20%: 0.7 mL/kg ( 0.7 mL X 70 kg = 49 mL).Loading dose: 140 mg/kg = 0.7 mL/kg of 20% acetylcysteine solution.(Refer to Potential Hazards section below) Rarely, oral dosing is necessary for patients who develop refractory anaphylactoid reactions to intravenous acetylcysteine. Contact the Atlantic Canada Poison Centre for details. †In massive overdoses of acetaminophen resulting in coma, metabolic acidosis, and elevated lactate, higher doses of N-acetylcysteine during the third infusion may be required, particularly during hemodialysis. As soon as criteria for stopping NAC is reached, NAC can be discontinued. Bloodwork should be done every 4 to 12 hours (depending on the clinical scenario). If any of these criteria are not met, continue the NAC at the same concentration and rate as the 3 rd infusion. (in 1 L dextrose 5% in water over 16 hours) *†Īt the end of the 21 hr protocol, NAC may be discontinued if the following criteria are met: Negative acetaminophen level, INR less than or equal to 1.5, AST or ALT less than 50 IU/L OR, if elevated, declining and approximately 50% of the peak value measured.

(in 500 mL dextrose 5% in water over 4 hours) (in 200 mL dextrose 5% in water over 60 minutes)

Third Infusion: 100 mg/kg acetylcysteine IV in 1000 mL dextrose 5% in water over 16 hours *†.

Second Infusion: 50 mg/kg acetylcysteine IV in 500 mL dextrose 5% in water over 4 hours, immediately followed by:.

Loading Dose: 150 mg/kg acetylcysteine IV in 200 mL dextrose 5% in water over 60 minutes immediately followed by:.Fulminant hepatic failure due to acetaminophen overdose or other hepatotoxic toxins.Repeated supratherapeutic (chronic) acetaminophen ingestion.Acute acetaminophen overdose (refer to Matthew-Rumack nomogram at end of monograph).Parvolex, Mucomyst, N-Acetylcysteine, NACĪLERT: NS / PEI / NB hospitals: Please use 'Acetylcysteine - Single Concentration'.

Mucomyst antidote