What Is the Rate of Adverse Events after Oral N-Acetylcysteine Administered by the Intravenous Route to Patients with Suspected Acetaminophen Poisoning?

Louise W. Kao, Mark A. Kirk, R. Brent Furbee, Nimish H. Mehta, Jason R. Skinner, Edward J. Brizendine

Research output: Contribution to journalArticle

70 Scopus citations


Study objective: We conduct a study to determine the rate of adverse events (anaphylactoid and cardiorespiratory) associated with the use of oral N-acetylcysteine by the intravenous route for the treatment of suspected acetaminophen poisoning and to examine specific variables that may be associated with adverse events. Methods: We conducted a retrospective medical record review with explicit criteria. All patients who received oral N-acetylcysteine by the intravenous route from September 1995 to September 2001 were included. Patients were identified by cross-matching 3 databases. Adverse events were divided into categories of cutaneous, systemic, or life threatening. Five reviewers abstracted charts by using a standardized data collection form. Interrater reliability was calculated by using 24 medical records abstracted by all 5 reviewers. Results: There were 7 adverse events identified in 187 patients (3.7%; 95% confidence interval 1.0% to 6.5%). Six adverse events were cutaneous and responded rapidly to antihistamines. One adverse event was life threatening but not clearly related to N-acetylcysteine. A high rate of antihistamine exposure (53%) was identified before the administration of N-acetylcysteine. Interrater agreement was higher than 95%. Conclusion: Intravenous administration of an oral solution of N-acetylcysteine is associated with a low rate of adverse events and should be considered for selected patients with suspected acetaminophen poisoning.

Original languageEnglish (US)
Pages (from-to)741-750
Number of pages10
JournalAnnals of emergency medicine
Issue number6
StatePublished - Dec 2003


ASJC Scopus subject areas

  • Emergency Medicine

Cite this