Abstract
Paracetamol poisoning continues to be a worldwide problem and despite
the availability of an affective antidote, N-acetylcysteine (NAC), the
optimal way to use this antidote, particularly following very large
doses of paracetamol, has not been established. Recent case series have
shown an increased toxicity from paracetamol, even in those receiving
prompt NAC therapy, at high doses of paracetamol, particularly in
patients above the 300 mg/L nomogram treatment line. Clinical trial
evidence supporting shorter NAC dosing now allows the possibility for
intensifying treatment without the risk of very high rates of ADRs. New
biomarkers also show the possibility of early identification of patients
at risk of liver injury who might also benefit from increased intensity
treatment. This article discusses these data and proposes a logical
therapy for increasing NAC dosing which now requires clinical trial
testing.