Comparison of Two-Bag and Three-Bag N-acetyl cysteine Treatment Protocols in Acute Acetaminophen Poisoning: A Quasi-Experimental Study
International Pharmacy Acta,
Vol. 7 No. 1 (2024),
24 July 2024
,
Page 1-6
https://doi.org/10.22037/ipa.v7i1.45643
Abstract
Acetaminophen poisoning is a major medical challenge requiring effective interventions. N-acetyl cysteine (NAC) is a commonly used antidote. While the FDA has approved the three-bag method, some sources suggest that the two-stage treatment offers comparable effectiveness in preventing liver damage, resulting in fewer adverse reactions, a lower risk of anaphylaxis, and more flexibility in timing adjustments. This study aimed to compare the clinical outcomes and adverse effects of the two-bag and three-bag NAC prescription methods in individuals with acetaminophen poisoning. In this prospective, double-blind, quasi-experimental study, patients with paracetamol overdose who required NAC (N-acetylcysteine) treatment over a one-year period at Loghman Hakim Hospital in Tehran were included. The two-bag regimen consisted of a loading dose followed by a maintenance dose, while the three-bag regimen included three separate doses. Clinical parameters such as blood levels of aspartate aminotransferase (AST), alanine transaminase (ALT), and alkaline phosphatase (ALP), along with demographic data (age, gender) and poisoning characteristics (ingested dose, blood acetaminophen levels, time of overdose), as well as adverse reactions to NAC, were examined. A total of 61 patients participated in the two-bag group and 49 people in the three-bag group. A significant decrease was found in AST in both groups (p < 0.05) compared to the time of arrival, and a significant decrease in ALP was seen only in the two-bag group (p = 0.007). No cases of hepatotoxicity or acute liver injury were observed. The two groups had no significant difference in the average NAC consumed and the patients' adverse reaction to NAC. The initial and discharge levels of liver enzymes ALT, AST, and ALP did not show a statistically significant difference between the two groups. The two-bag method may be a viable alternative to the traditional three-bag method, as it can ease the workload for ward nurses and has not resulted in any reported deaths.
- Acetaminophen
- Poisoning
- Acetylcysteine
- Medication Therapy Management
How to Cite
References
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