Table 1.

Clinical Experience of N-acetylcysteine for Distal Intestinal Obstruction Syndrome

Reference	Population	NAC Formulation, %	Goal of NAC Therapy	Outcome	Adverse Effects
Burke6	In vivo: mice	4	To quantitate the dry weight of stool and measure toxicity	4% NAC resulted in less stool output than controls	Minor intestinal mucosal changes
	In vivo: meconium from term, healthy, human newborns		To assess the ability of the test solution to break down meconium	69% decrease in meconium viscosity immediately, over 99% viscosity reduction at 6 hours	N/A
Parrish12	25-yr-old F with CF	4	To relieve intestinal obstruction	120 mL evacuated	None reported
		4	To prevent recurrence of intestinal obstruction	Discharged on postoperative day 15 without further GI complications
Khaitov1	19-yr-old F with CF	Not reported	Resolution of ileus	Not successful for initial disimpaction	None reported
Lillibridge13	26-yr-old M with CF	Not reported	Prevention of intestinal obstruction	Complete resolution of abdominal symptoms	None reported
			Treatment of intestinal obstruction followed by a weekly enema for obstruction prevention	Successfully treated
Mabogunje14	2 neonates with radiologically confirmed MI	Not reported	To relieve intestinal obstruction	Unsuccessful in both patients	None reported
Garza-Cox15	8 premature (VLBW infants)	20	To relieve intestinal obstruction	Successful in 2/8 patients	None reported
Shaw11	48 puppies 3 days to 3 mo	2–20	To assess the effects of varying concentrations and volumes of NAC on fluid volumes in the bowel, changes in hematocrit, and microscopic tissue analysis	Not assessed	20% NAC caused extensive fluid shifts, hyperemia, and multiple hemorrhages; effects were more severe in younger puppies
Bailey9	3-yr-old M with CF	4	To relieve intestinal obstruction	Progression to a diatrizoate meglumine and diatrizoate sodium enema for disimpaction	Liver biopsy confirmed drug-induced liver injury
Cooke16	Neonate born at 38-wk gestational age with CF	0.2	To relieve intestinal obstruction	Successful response	Dramatic increase in transaminases and bilirubin following NAC administration
Langer8	Premature infant, 30-wk gestational age with MI	5	To relieve intestinal obstruction	Successful response	Hypernatremia; returned to normal within 24 hours after discontinuation

CF, cystic fibrosis; F, female; GI, gastrointestinal; M, male; MI, meconium ileus; N/A, not applicable; NAC, N-acetylcysteine; VLBW, very low birth weight