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Table 36.9

Acetylcysteine (AC) Regimen in Paracetamol Poisoning

150 mg/kg in 200 mL glucose 5% IV over 1h, then

50 mg/kg in 500 mL glucose 5% IV over 4h, then

100 mg/kg in 1L glucose 5% IV over 16h

Minor reactions to acetylcysteine (nausea, flushing, urticaria and pruritus) are relatively common, and usually settle when the peak rate of infusion is passed. If there is a severe reaction (angioedema, wheezing, respiratory distress, hypotension or hypertension), stop the infusion and give an antihistamine (chlorphenamine 10 mg IV over 10 min). Then re-start the acetylcysteine infusion at the lowest rate (100 mg/kg in 1L glucose 5% IV over 16h).