Paracetamol poisoning: a prospective comparison of 2 protocols for N-acetylcysteine treatment
Por:
Supervía A, Gispert MªÀ, Puiguriguer J, Álvarez Zabala PB, Martínez-Sánchez L, Olmos S, Calderón B, Paz Picornell R, Nogué S and Córdoba F
Publicada:
1 feb 2025
Resumen:
Background and objective. Paracetamol poisoning can be serious and require treatment with N-acetylcysteine (NAC). A dose of 300 mg/kg is usually given in 3 fractions over 21 hours. An alternative regimen, the Scottish and Newcastle Acetylcysteine Protocol (SNAP), specifies the same total dose given in 2 intravenous injections over 12 hours. This study aimed to compare the 2 regimens in terms of effectiveness, adverse events, and lengths of emergency department (ED) and hospital stays. Methods. Prospective multicenter study to compare outcomes associated with the traditional NAC regimen vs SNAP. We enrolled all patients with paracetamol poisoning requiring NAC treatment in the participating hospital EDs from 2021 through 2023. Data related to referrals, poisoning episodes, and discharge destinations were collected. Patients were studied in 2 groups according to the protocol assigned in the EDs. Results. A total of 165 patients were treated (SNAP, 103; traditional protocol, 62). The mean (SD) age was 28.1 (19.7) years, and most were female (70.5%). No differences in peak transaminase levels were observed. SNAP-treated patients had significantly fewer adverse effects as well as shorter stays both in the ED (17.8 [15.2] hours vs 25.9 [17.1] hours; P = .001) and on the ward (2.6 [2.3] days vs 4.4 [3.6] days; P = .019). Conclusions. Fewer adverse events occurred with the SNAP approach. The 2 protocols were similarly effective. The SNAP-treated patients spent less time in the ED, and those who were admitted to hospital had shorter stays.
Filiaciones:
Supervía A:
Servicio de Urgencias, Hospital Universitario del Mar, Barcelona, España. Unitat Funcional de Toxicología, Hospital Universitario del Mar, Barcelona, España. Grup de treball de Toxicologia de la SoCMUE (SoCMUETox)
Gispert MªÀ:
Grup de treball de Toxicologia de la SoCMUE (SoCMUETox). Servicio de Urgencias, Hospital Dr. Josep Trueta, Girona, España
Puiguriguer J:
Servicio de Urgencias, Hospital Son Espases, Palma de Mallorca, España
Álvarez Zabala PB:
Servicio de Pediatría, Hospital Sant Joan de Déu, Barcelona, España
Martínez-Sánchez L:
Grup de treball de Toxicologia de la SoCMUE (SoCMUETox). Servicio de Urgencias de Pediatría, Hospital Sant Joan de Déu, Barcelona, España. Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España
Olmos S:
Grup de treball de Toxicologia de la SoCMUE (SoCMUETox). Servicio de Urgencias, Consorci Sanitari Parc Taulí, Sabadell, Barcelona, España
Calderón B:
Servicio de Urgencias, Hospital Son Llàtzer, Palma de Mallorca, España
Paz Picornell R:
Servicio de Urgencias, Hospital Universitario del Mar, Barcelona, España
Nogué S:
Grup de treball de Toxicologia de la SoCMUE (SoCMUETox). Fundación Española de Toxicología Clínica
Córdoba F:
Grup de treball de Toxicologia de la SoCMUE (SoCMUETox). Servicio de Urgencias, Hospital Moisès Broggi Sant Joan Despí, Barcelona, España
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