Comparison of Two-Bag Versus Three-Bag N-Acetylcysteine Regimens for Pediatric Acetaminophen Toxicity.
Ann Pharmacother
; 57(1): 36-43, 2023 01.
Article
em En
| MEDLINE
| ID: mdl-35587124
ABSTRACT
BACKGROUND:
Acetaminophen overdose is a leading cause of liver failure, and a leading cause of pediatric poisoning requiring hospital admission. The antidote, N-acetylcysteine (NAC), is traditionally administered as a three-bag intravenous infusion. Despite its efficacy, NAC is associated with high incidence of nonallergic anaphylactoid reactions (NAARs). Adult evidence demonstrates that alternative dosing regimens decrease NAARs and medication errors (MEs).OBJECTIVES:
To compare NAARs and MEs associated with two- versus three-bag NAC for acetaminophen overdose in a pediatric population.METHODS:
This is a retrospective observational cohort study comparing pediatric patients who received three- versus two-bag NAC for acetaminophen toxicity. The primary outcome was incidence of NAARs. Secondary outcomes were rates of MEs and relevant hospital outcomes (length of stay [LOS], intensive care unit (ICU) admission, liver transplant, death).RESULTS:
Two hundred forty-three patients met inclusion criteria (median age of 15 years) 150 (62%) three-bag NAC and 93 (38%) two-bag NAC. There was no difference in overall NAARs (p = 0.54). Fewer cutaneous NAARs were observed in the two-bag group, three-bag 15 (10%), two-bag 2 (2%), p = 0.02. MEs were significantly decreased with the two-bag regimen, three-bag 59 (39%), two-bag 21 (23%), p = 0.01. No statistical differences were observed in LOS, ICU admissions, transplant, or death. CONCLUSION AND RELEVANCE A significant decrease in cutaneous NAARs and MEs was observed in pediatric patients by combining the first two bags of the traditional three-bag NAC regimen. In pediatric populations, a two-bag NAC regimen for acetaminophen overdose may improve medication tolerance and safety.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Analgésicos não Narcóticos
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Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos
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Overdose de Drogas
Limite:
Adolescent
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Adult
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Child
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Humans
Idioma:
En
Ano de publicação:
2023
Tipo de documento:
Article