GuidelinesOther guideline
Infusion: N-Acetylcysteine
N-ACETYLCYSTEINE INFUSION / PARVOLEX
| Trade names: | Presentation and strength: |
Parvolex | 200mg/ml in 10ml ampoules (2g) |
| Cautions: see SAMF. Anaphylaxis risk & histamine release. If only mild reaction reduce infusion rate. Stop if severe reaction Commence N-Acetylcysteine (NAC) when acute paracetamol ingestion exceeds 10g or > 200mg/kg (whichever is less) in adults and > 200mg/kg in children Commence NAC plasma concentration is above treatment line on Rumack-Matthew Nomogram (attached). Paracetamol plasma concentration should be obtained 4 hours after ingestion or soonest thereafter. Use high risk treatment line for patients with liver impairment, alcohol abusers and patients taking enzyme inducing medication | |
| Loading dose: | |
| Adult: 150 mg/kg in 200ml 5% Dex over 1 hour then 50 mg/kg in 500ml 5%Dex over 4 hours then 100mg/kg in 1000ml 5% Dex over 16 hours | Paediatric: As for adult. |
| Commonly for 70kg adult: 10.5g (52.5ml) NAC in 200 ml 5% Dex 3.5g (17.5ml) NAC in 500 ml 5% Dex 7g (35ml) NAC in 1000ml 5% Dex | Neonatal: As for paediatric. |
| Constant infusion: | |
| In patients developing hepatic injury continue NAC until LFT’s normalised: 150mg/kg in 1 litre 5%Dex over 24 hours. Rate 42 ml/hr | Paediatric dosage range: As for adult. |
| Neonatal dosage range: As for paediatric. | |
| Regime for 70kg adult: | Regime for paediatrics: |
| Mixture: 10.5g (52.5ml) NAC in 200 ml 5% Dex 3.5g (17.5ml) NAC in 500 ml 5% Dex 7g (35ml) NAC in 1000ml 5% Dex | Mixture: Per weight – calculate to above regime |
| Rate: Run at 200ml/hr for 1 hour Run at 125ml/hr for 4 hours then Run at 62.5ml/hr for 16 hours | Rate: In children adapt volume of IV fluid to age and weight appropriate volume |
| Alternative adult regime: | Alternative paediatric regime: |
| Mixture: | Mixture: |
| Rate: | Rate: |
| Additional notes: Monitor Serum potassium | |
RUMACK-MATTHEW NOMOGRAM
*The nomogram is only for use with single acute ingestion
Nomogram reproduced from the Guidelines for the management of Acute Paracetamol Overdose produced by the Medicines Information Centre, UCT