Abstract
Introduction
We sought to compare antiemetic use after acetaminophen poisoning in patients treated with oral or intravenous (IV) N-acetylcysteine (NAC).
Methods
Our retrospective chart review identified 20 orally treated patients and 17 IV-treated patients. For both groups, we calculated the total number of antiemetic doses given, their associated cost, and also determined parameters that correlated with antiemetic use.
Results
IV-treated patients received fewer total antiemetic doses than those receiving oral NAC (1.1 ± 0.2 vs. 2.8 ± 0.7; P = 0.04). Antiemetic cost correlated with doses received for both groups; however, because the regression lines differed (P = 0.02), antiemetic therapy cost was less in IV-treated patients. In addition, serum acetaminophen concentration correlated with total antiemetic doses in oral NAC patients (P < 0.002) but not with IV treatment patients (P = 0.78).
Conclusions
Intravenous NAC reduced antiemetic utilization, and it costs less than oral therapy. Furthermore, antiemetic use appeared to be determined by a combination of acetaminophen concentration and NAC administration route.
Keywords: acetaminophen, antiemetics, n-acetylcysteine, overdose
Full Text
The Full Text of this article is available as a PDF (142.6 KB).
Footnotes
There was no outside funding of any kind used for this study.
References
- 1.Smilkstein MJ, Knapp GL, Kulig KW, Rumack BH. Efficacy of oral N-Acetylcysteine in the treatment of acetaminophen overdose. Analysis of the national multicenter study (1976 to 1985) N Engl J Med. 1988;319:1557–1562. doi: 10.1056/NEJM198812153192401. [DOI] [PubMed] [Google Scholar]
- 2.Vale JA, Proudfoot AT. Paracetamol (acetaminophen) poisoning. Lancet. 1995;346:547–552. doi: 10.1016/S0140-6736(95)91385-8. [DOI] [PubMed] [Google Scholar]
- 3.Linden CH, Rumack BH. Acetaminophen overdose. Emerg Med Clin North Am. 1984;2:103–119. [PubMed] [Google Scholar]
- 4.Scharman EJ. Use of ondansetron and other antiemetics in the management of toxic acetaminophen ingestions. J Toxicol Clin Toxicol. 1998;36:19–25. doi: 10.3109/15563659809162578. [DOI] [PubMed] [Google Scholar]
- 5.Perry HE, Shannon MW. Efficacy of oral versus intravenous N-Acetylcysteine in acetaminophen overdose: Results of an open-label, clinical trial. J Pediatr. 1998;132:149–152. doi: 10.1016/S0022-3476(98)70501-3. [DOI] [PubMed] [Google Scholar]
- 6.Ternullo S. Acetadote (intravenous acetylcysteine): adverse effects more significant than with oral acetylcysteine. J Emerg Nurs. 2006;32:98–100. doi: 10.1016/j.jen.2005.09.015. [DOI] [PubMed] [Google Scholar]
- 7.Kao LW, Kirk MA, Furbee RB, Mehta NH, Skinner JR, Brizendine EJ. What is the rate of adverse events after oral n-acetylcysteine administered by the intravenous route to patients with suspected acetaminophen poisoning? Ann Emerg Med. 2003;42:741–750. doi: 10.1016/S0196-0644(03)00508-0. [DOI] [PubMed] [Google Scholar]
- 8.Murray L. Red Book. Montvale, NJ: Thomson; 2005. [Google Scholar]
- 9.Kovac AL. Benefits and risks of newer treatments for chemotherapy-induced and postoperative nausea and vomiting. Drug Saf. 2003;26:227–259. doi: 10.2165/00002018-200326040-00003. [DOI] [PubMed] [Google Scholar]
- 10.Braude D, Soliz T, Crandall C, Hendey G, Andrews J, Weichenthal L. Antiemetics in the ED: a randomized trial comparing 3 common agents. Am J Emerg Med. 2006;24:177–182. doi: 10.1016/j.ajem.2005.08.017. [DOI] [PubMed] [Google Scholar]
- 11.Wright RO, Anderson AC, Lesko SL, Woolf AD, Linakis JG, Lewander WJ. Effect of metoclopramide dose on preventing emesis after oral administration of N-Acetylcysteine for acetaminophen overdose. J Toxicol Clin Toxicol. 1999;37:35–42. doi: 10.1081/CLT-100102406. [DOI] [PubMed] [Google Scholar]
- 12.Clark F, Chen R, Williams SR, Johnson CL, Harchelroad F. The use of ondansetron in the treatment of nausea and vomiting associated with acetaminophen poisoning. J Toxicol Clin Toxicol. 1996;34:163–167. doi: 10.3109/15563659609013765. [DOI] [PubMed] [Google Scholar]
- 13.James LP, Simpson PM, Farrar HC, Kearns GL, Wasserman GS, Blumer JL, et al. Cytokines and toxicity in acetaminophen overdose. J Clin Pharmacol. 2005;45:1165–1171. doi: 10.1177/0091270005280296. [DOI] [PubMed] [Google Scholar]