{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T02:35:14Z","timestamp":1777602914220,"version":"3.51.4"},"reference-count":28,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,1,18]],"date-time":"2026-01-18T00:00:00Z","timestamp":1768694400000},"content-version":"vor","delay-in-days":17,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100011365","name":"ACEM Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100011365","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["1159907"],"award-info":[{"award-number":["1159907"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Medical Journal of Australia"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To determine whether ceasing acetylcysteine treatment for adults with acute paracetamol overdose after at least 12\u2009h of the two\u2010bag acetylcysteine regimen is non\u2010inferior to providing the full 20\u2010h two\u2010bag regimen.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>Open label, non\u2010inferiority randomised controlled trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Emergency departments of six Australian metropolitan hospitals (four in Melbourne, two in Sydney), 1 December 2019\u201331 July 2024.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Adults who required acetylcysteine treatment following single or staggered paracetamol ingestions whose serum alanine transaminase (ALT) level was below 40\u2009IU\/L on presentation, and whose ALT levels were below 40\u2009IU\/L and serum paracetamol concentrations below 20\u2009mg\/L after 12 h of acetylcysteine treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Intervention<\/jats:title>\n                    <jats:p>\n                      <jats:italic>Control group<\/jats:italic>\n                      (standard care): two\u2010bag intravenous acetylcysteine regimen (200\u2009mg\/kg over 4\u2009h, followed by 100\u2009mg\/kg over 16\u2009h).\n                      <jats:italic>Intervention group<\/jats:italic>\n                      : Acetylcysteine stopped at least 12\u2009h after treatment initiation and the 20\u2010h infusion period completed with intravenous compound sodium lactate.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcome Measures<\/jats:title>\n                    <jats:p>Difference in ALT level between presentation and 20\u2009h after acetylcysteine treatment initiation; non\u2010inferiority was defined as the upper limit of the 95% confidence interval (CI) of the difference between median changes in ALT level for the intervention and control groups being less than 3\u2009IU\/L.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 2830 people who presented with paracetamol overdose, 860 received acetylcysteine treatment; 186 people who met both the presentation and 12\u2010h acetylcysteine treatment blood test inclusion criteria (median age, 17\u2009years; interquartile range [IQR], 16\u201323\u2009years; 162 women [87%]) were randomly assigned to the intervention (93 participants) and control groups (93 participants). Median acetylcysteine infusion time in the intervention group was 13\u2009h (IQR, 13\u201313 h). The median change in ALT level between arrival and 20\u2009h after starting intravenous acetylcysteine treatment was similar for the intervention (\u22121\u2009IU\/L; IQR, \u22124 to 1\u2009IU\/L) and control groups (0\u2009IU\/L; IQR, \u22122 to 2\u2009IU\/L); the difference in median change (\u22121\u2009IU\/L; 95% CI, \u22122 to 1\u2009IU\/L) was consistent with the non\u2010inferiority criterion. No patients developed hepatic injury or hepatotoxicity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>An abbreviated acetylcysteine treatment regimen was non\u2010inferior to the standard 20\u2010h two\u2010bag regimen for people with paracetamol overdose who were at low risk of hepatic failure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>ACTRN12619001549112 (prospective)<\/jats:p>\n                  <\/jats:sec>","DOI":"10.5694\/mja2.70114","type":"journal-article","created":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T05:24:54Z","timestamp":1768800294000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Early Cessation of Acetylcysteine Treatment After Paracetamol Overdose 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