Preventing Interruptions During IV NAC Therapy

Background

The FDA-approved dosing for IV acetylcysteine (NAC) for acetaminophen overdose is complicated: a 1-hour loading dose, followed by a 4-hour maintenance infusion at a different rate, followed by a second maintenance infusion for 16 hours at yet a different rate. Back during my clinical toxicology fellowship, we published a study that found there was an interruption in antidotal therapy > 1 hour in 18.6% of cases (and medication errors in 33% of cases overall). [1]
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