In this section
General Management of Acute Poisoning Guideline
Consider the possibility of co ingestions,
either accidental or deliberate
The standard administration of NAC is a 3 stage infusion giving
a total dose of 300 mg/kg:
For patients > 110 kg, calculate the dose based on 110 kg
NAC may be diluted in 5% dextrose or 0.9% saline (normal
saline). It can also be diluted in combination
dextrose-saline solutions not exceeding these concentrations
including 0.45% saline in 5% dextrose, and 0.9% saline in 5%
The volume and choice of fluid for each stage of the infusion
needs to be appropriate for the age and weight of the child and
clinical circumstances. In the adolescent patient, it is
generally appropriate to follow the standard published
recommendations for NAC administration and use convenient volumes
For adolescent / adult:
However, this results in a total of 1700 mls of 5% dextrose
which is inappropriate for smaller children.
For smaller children a suggested approach
Dilute in (saline or dextrose)
250 ml bag
1 hour (250 ml/hr)
4 hours (65 ml/hr)
16 hours (15 ml/hr)
For infants , even smaller volumes may be
required. Doses can be diluted in 100 ml bags if available or
added to an appropriate volume in a burette.
In all cases, additional maintenance fluids can be given if
required, or NAC may be administered in larger volume bags if more
Anaphylactoid reactions to NAC may occur
(wheeze, rash). In these cases, cease the infusion for 30
minutes, give promethazine then recommence the infusion at half the
previous rate. Slowly increase the rate until the desired
rate is again reached.
Evidence suggests those treated with NAC
within 8 hours of ingestion can cease the infusion after 21 hours
without the need for LFT monitoring or further investigation.
In those presenting with delayed toxic ingestions or after multiple
supratherapeutic dose toxicity, LFT monitoring can be used to
determine the duration of NAC therapy. If ALT is elevated at
the completion of the 21 hour infusion, NAC should be continued at
the current rate and specialist advice sought.
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