Peer Reviewed Title: Oral and Intravenous Acetylcysteine for Treatment of Acetaminophen Toxicity: A Systematic Review and Meta-analysis

Introduction: There are few reports summarizing the effectiveness of oral and intravenous (IV) acetylcysteine. We determined the proportion of acetaminophen poisoned patients who develop hepatotoxicity (serum transaminase > 1000 IU/L) when treated with oral and IV acetylcysteine.

[1]  M. Lovegrove,et al.  Characterization of acetaminophen overdose‐related emergency department visits and hospitalizations in the United States , 2011, Pharmacoepidemiology and drug safety.

[2]  R. Clark,et al.  A multicenter comparison of the safety of oral versus intravenous acetylcysteine for treatment of acetaminophen overdose , 2010, Clinical toxicology.

[3]  Tara L. Pummer,et al.  Cost minimization analysis comparing enteral N-acetylcysteine to intravenous acetylcysteine in the management of acute acetaminophen toxicity , 2010, Clinical toxicology.

[4]  A. Marchetti,et al.  Managing acute acetaminophen poisoning with oral versus intravenous N-acetylcysteine: a provider-perspective cost analysis , 2009, Journal of medical economics.

[5]  R. Clark,et al.  A retrospective evaluation of shortened-duration oral N-acetylcysteine for the treatment of acetaminophen poisoning , 2009, Journal of Medical Toxicology.

[6]  I. Stiell,et al.  Comparison of the 20-hour intravenous and 72-hour oral acetylcysteine protocols for the treatment of acute acetaminophen poisoning. , 2009, Annals of emergency medicine.

[7]  S. Doyon,et al.  Hepatotoxicity despite early administration of intravenous N-acetylcysteine for acute acetaminophen overdose. , 2009, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[8]  K. Heard,et al.  Acetylcysteine for acetaminophen poisoning. , 2008, The New England journal of medicine.

[9]  R. Clark,et al.  A prospective evaluation of shortened course oral N-acetylcysteine for the treatment of acute acetaminophen poisoning. , 2007, Annals of emergency medicine.

[10]  I. Whyte,et al.  Safety and efficacy of intravenous N‐acetylcysteine for acetaminophen overdose: analysis of the Hunter Area Toxicology Service (HATS) database , 2007, Current medical research and opinion.

[11]  H. Spiller,et al.  Efficacy of activated charcoal administered more than four hours after acetaminophen overdose. , 2006, The Journal of emergency medicine.

[12]  D. Juurlink,et al.  A risk quantification instrument for acute acetaminophen overdose patients treated with N-acetylcysteine. , 2005, Annals of emergency medicine.

[13]  I. Whyte,et al.  The Australasian Clinical Toxicology Investigators Collaboration randomized trial of different loading infusion rates of N-acetylcysteine. , 2005, Annals of emergency medicine.

[14]  P. Walson,et al.  A patient-tailored N-acetylcysteine protocol for acute acetaminophen intoxication. , 2005, Clinical therapeutics.

[15]  Chu-Lin Tsai,et al.  Acute acetaminophen intoxication in Taiwan: outcomes and risk factors. , 2004, Journal of the Formosan Medical Association = Taiwan yi zhi.

[16]  L. Borgström,et al.  Pharmacokinetics of N-acetylcysteine in man , 2004, European Journal of Clinical Pharmacology.

[17]  L. Yip,et al.  A 20-hour treatment for acute acetaminophen overdose. , 2003, The New England journal of medicine.

[18]  P. Dargan,et al.  Fatal anaphylactoid reaction to N-acetylcysteine: caution in patients with asthma , 2002, Emergency medicine journal : EMJ.

[19]  I. Anderson,et al.  Shorter duration of oral N -Acetylcysteine therapy for acute acetaminophen overdose. , 2000, Annals of emergency medicine.

[20]  A. Woolf,et al.  Effect of metoclopramide dose on preventing emesis after oral administration of N-acetylcysteine for acetaminophen overdose. , 1999, Journal of toxicology. Clinical toxicology.

[21]  I. Whyte,et al.  Oral or intravenous N-acetylcysteine: which is the treatment of choice for acetaminophen (paracetamol) poisoning? , 1999, Journal of toxicology. Clinical toxicology.

[22]  J. Critchley,et al.  Renal failure is uncommon in Chinese patients with paracetamol (acetaminophen) poisoning. , 1995, Veterinary and human toxicology.

[23]  J. Diamond,et al.  A prospective evaluation of the effect of activated charcoal before oral N-acetylcysteine in acetaminophen overdose. , 1994, Annals of emergency medicine.

[24]  K. Kulig,et al.  Acetaminophen overdose: a 48-hour intravenous N-acetylcysteine treatment protocol. , 1991, Annals of emergency medicine.

[25]  G. Alexander,et al.  Improved outcome of paracetamol-induced fulminant hepatic failure by late administration of acetylcysteine , 1990, The Lancet.

[26]  P. Routledge,et al.  Safety of Late Acetylcysteine Treatment in Paracetamol Poisoning , 1990, Human & experimental toxicology.

[27]  C. Federiuk.  Efficacy of N-acetylcysteine in the treatment of acetaminophen overdose: Smilkstein MJ, Knapp GI, Kulig KW, et al N Engl J Med 319: 1557–1562 Dec 1988 , 1989 .

[28]  G. Knapp,et al.  Efficacy of oral N-acetylcysteine in the treatment of acetaminophen overdose. Analysis of the national multicenter study (1976 to 1985) , 1988, The New England journal of medicine.

[29]  B. Rumack.  Acetaminophen overdose in young children. Treatment and effects of alcohol and other additional ingestants in 417 cases. , 1984, American journal of diseases of children.

[30]  G. Koch,et al.  Acetaminophen overdose. 662 cases with evaluation of oral acetylcysteine treatment. , 1981 .

[31]  L. Prescott.  Treatment of severe acetaminophen poisoning with intravenous acetylcysteine. , 1981, Archives of internal medicine.

[32]  B. Rumack,et al.  Acetaminophen overdose: incidence, diagnosis, and management in 416 patients. , 1978, Pediatrics.

[33]  A. Proudfoot,et al.  TREATMENT OF PARACETAMOL (ACETAMINOPHEN) POISONING WITH N-ACETYLCYSTEINE , 1977, The Lancet.