N-acetylcysteine for Acetaminophen Poisoning Without Hepatotoxicity: the Effect on the Prothrombin Time.
- Author:
Won Jae LEE
1
;
Kyu Nam PARK
;
Seung Pil CHOI
;
Mi Jin LEE
;
Jung Hee WEE
;
Byung Hak SO
Author Information
1. Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea. emmam@catholic.ac.kr
- Publication Type:Original Article
- Keywords:
Acetaminophen;
Poisoning;
N-acetylcysteine;
Prothrombin time
- MeSH:
Acetaminophen*;
Acetylcysteine*;
Diagnosis;
Humans;
Liver Failure;
Medical Records;
Poisoning*;
Prothrombin Time*;
Prothrombin*
- From:Journal of the Korean Society of Emergency Medicine
2005;16(2):281-286
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: In patients with acetaminophen poisoning, clinical severities are partly based on the prothrombin time. In several conditions, N-acetylcysteine (NAC) infusion has been shown to lower the prothrombin index. Thus, we studied the effect of NAC on the prothrombin time in patients intoxicated with acetaminophen without hepatotoxicity. METHODS: From March 2000 to Aug 2004, we reviewed the medical records of 149 patients with a diagnosis of acetaminophen poisoning. After 88 patients had been excluded (29 had hepatocellular injury, 14 had a probable risk based on their normogram, and 45 had a missing prothrombin index value), 61 patients were included in the analysis. The prothrombin time was recorded before and serially during NAC treatment. RESULTS: The mean baseline prothrombin time was 99.1%, 99.3% after intravenous NAC infusion, and 74.0% at 8 hrs after initiation of NAC infusion. It decreased rapidly at 16 hrs, and reached a steady baseline state between 16 to 24 hrs. A rapid increase in the baseline time occurred after 2-3 days when the NAC infusion was stopped. After oral NAC treatment, it decreased rapidly from 8 to 16 hrs, and reached a steady baseline after 2 days. There was a rapid increase after 3~4 days when the NAC infusion was stopped. CONCLUSION: In patients with uncomplicated acetaminophen poisoning, the decrease in the prothrombin index might be misinterpreted as a sign of liver failure, leading to a prolonged treatment.
