The total volume administered should be adjusted for patients less than 40 kg (88 lbs) and for those requiring fluid restriction. 2015 39:594-599.Use the Acetadote dosage calculator to calculate the accurate dose of Acetadote for your patients.Įnter your patient's weight below and click "Calculate." Efficacy and safety of acetylcysteine in “non-acetaminophen” acute liver failure: A metaanalysis of prospective clinical trials. N-acetylcysteine for non-paracetamol drug-induced liver injury: a systematic review. Chughlay MF, Kramer N, Spearman CW, Werfalli M, Cohen K.Treasure Island (FL): StatPearls Publishing 2021 Jan. As always, more data is needed, but with NAC’s low side effect profile and upside in the setting of acute liver injury and failure, it should at least be crossing the minds of emergency physicians early on for these patients. Other causes of acute liver failure are inevitably going to present in the emergency department and acknowledging that NAC likely has a place in the care of these patients is important to consider. The scope of use for this medication beyond that is often not considered, such as in other etiologies of acute liver failure like viral hepatitis, infection, autoimmune, etc.Īs demonstrated by this meta-analysis, the data is difficult to come by, however, as more comes to light, the signal within suggests NAC has more to offer than just an antidote to acute liver failure in the setting of acetaminophen overdose. NAC is well known to emergency medicine physicians as the antidote in acute acetaminophen ingestion. Time frame of studies spans broad time periods which lends itself to bias in that clinical practice was different in the 1990s compared to now.6 of 7 studies had NAC was given IV, leaving the question open for oral NAC.Children and the elderly could differ in causes of acute liver failure and limit generalizability to the greater population between these age groups.Most studies were single-institution, limiting generalizability.Only 2 of the 7 studies were randomized controlled trials.Only 5% of patients in this meta-analysis had drug-induced liver failure, supporting the hypothesis that NAC is useful outside of drug-induced liver failure.Broad etiologies of acute liver failure (drug-induced, viral, autoimmune, metabolic, other).Literature review and data extraction by 2 independent authors.Length of stay was increased in the control group compared to NAC group, mean difference 7.79, (95% CI 6.93-8.66, p = Post-transplant survival favored the NAC group compared to control group, OR 2.44 (95% CI 1.11-3.57, p=0.03).Transplant free survival favored the NAC group compared to control group, OR 2.85 (95% CI, 2.11-3.85 p = Odds of survival 1.77 times higher (95% CI 1.30-2.41 p= Percentage of patients who did not receive a transplant and survived.Review articles or published as abstracts only.*In a patient who previously had no liver disease. Abnormal liver enzymes AND elevated international normalized ratio (INR) WITH or WITHOUT encephalopathy.Retrospective meta-analysis and systematic review of pooled data from 7 clinical trials To re-evaluate and determine the efficacy of n-acetylcysteine in non-acetaminophen-related acute liver injury. The study above provides evidence that suggests an overall improved survival rate with NAC in NAALF patients. 2,3 Given the grave sequelae of ALF, an updated investigation into whether the use of NAC can be utilized as an adjunct treatment in patients with NAALF was warranted. This statement was based on a single RCT, meta-analysis and systematic reviews that either were considered inconclusive or did not demonstrate mortality benefit. In 2011, the American Association for the Study of Liver Diseases published guidelines suggesting NAC may be beneficial in non-acetaminophen acute liver failure. 1 However, the use of NAC outside the realm of acute acetaminophen overdose for other causes of acute liver failure (ALF) is not as well described. N-acetylcysteine (NAC) is the first-line agent for treatment in acute acetaminophen overdose, functioning by repleting glutathione for the liver to use to neutralize the toxic metabolite of acetaminophen metabolism, NAPQI. Role of n-acetylcysteine in non-acetaminophen-related acute liver failure: an updated meta-analysis and systematic review. Walayat S, Shoaib H, Asghar M, Kim M, Dhillon S.
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