Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/27302
Title: A two-bag acetylcysteine regimen is associated with shorter delays and interruptions in the treatment of paracetamol overdose.
Austin Authors: O'Callaghan, Charlotte;Graudins, Andis ;Wong, Anselm Y 
Affiliation: Department of Medicine, School of Clinical Sciences at Monash Health. Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
Monash Toxicology and Emergency Department, Monash Health, Victoria, Australia
Toxicology
Department of Critical Care, Faculty of Medicine, University of Melbourne, Victoria, Australia
Emergency
Issue Date: 2022
Date: 2021
Publication information: Clinical Toxicology (Philadelphia, Pa.) 2022; 60(3): 319-323
Abstract: The three-bag intravenous (IV) acetylcysteine regimen for paracetamol overdose is associated with frequent and long delays during treatment. This has not been previously studied in regard to the two-bag regimen. Our primary aim was to compare the cumulative duration of delays during IV acetylcysteine infusion between the three-bag and two-bag regimens. Secondary aims were to compare the frequency of delays and to identify causes for delay. This was a retrospective cohort study of patients receiving IV acetylcysteine for the treatment of paracetamol overdose, conducted at three Australian emergency departments. A cohort of patients treated with the three-bag regimen from October 2009 to October 2013 was compared to patients treated with the two-bag regimen from February 2014 to May 2020. Start times of each infusion were sourced from medical records and delays were calculated by comparing actual infusion time against prescribed time. Evidence of adverse drug reactions - gastrointestinal reactions and cutaneous and systemic non-allergic anaphylactoid reactions (NAARs) - were also recorded. The three-bag cohort included 271 cases and the two-bag cohort included 598 cases. Delays were significantly shorter in the two-bag cohort, compared to the three-bag cohort: median delay 35 min (IQR: 15, 70) vs 65 min (IQR: 40, 105), p < 0.01. Delays longer than 1 h were less frequent in the two-bag cohort: 31% vs 51%, p < 0.01. NAARs were associated with significantly longer delays in both cohorts and were more frequent in the three-bag cohort. The two-bag regimen was associated with significantly fewer and shorter delays. NAARs, which were more frequent in the three-bag cohort, were associated with significantly longer delays.
URI: https://ahro.austin.org.au/austinjspui/handle/1/27302
DOI: 10.1080/15563650.2021.1966027
ORCID: 0000-0002-6817-7289
Journal: Clinical Toxicology (Philadelphia, Pa.)
PubMed URL: 34402711
Type: Journal Article
Subjects: NAC
acetaminophen overdose
delays
intravenous infusion
medication error
Appears in Collections:Journal articles

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