{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T07:54:15Z","timestamp":1789890855238,"version":"4.0.1"},"reference-count":27,"publisher":"The Pediatric Pharmacy Association","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2015]]},"abstract":"<jats:p>\n          <jats:bold>OBJECTIVE:<\/jats:bold> Conventionally, intravenous N-acetylcysteine (IV-NAC) administration is a 3-bag regimen administered over the course of 21 hours, which increases the risk of reconstitution and administration errors. To minimize errors, an alternative IV-NAC regimen consists of a loading dose (150 mg\/kg) followed by a maintenance infusion (15 mg\/kg\/hr) until termination criteria are met. The aim was to determine the clinical outcomes of an alternative IV-NAC regimen in pediatric patients.<\/jats:p>\n        <jats:p>\n          <jats:bold>METHODS:<\/jats:bold> A retrospective review of pharmacy dispensing records and diagnostic codes at a pediatric hospital identified patients who received alternative IV-NAC dosing from March 1, 2008, to September 10, 2012, for acetaminophen overdoses. Exclusion criteria included chronic liver disease, initiation of oral or other IV-NAC regimens, and initiation of standard IV-NAC infusion prior to facility transfer. Clinical and laboratory data were abstracted from the electronic medical record. Descriptive statistics were utilized. Clinical outcomes and adverse drug reaction incidences were compared between the alternative and Food and Drug Administration (FDA)\u2013approved IV-NAC regimens.<\/jats:p>\n        <jats:p>\n          <jats:bold>RESULTS:<\/jats:bold> Fifty-nine patients (mean age 13.4 \u00b1 4.3 years; range: 2 months-18 years) with acetaminophen overdoses were identified. Upon IV-NAC discontinuation, 45 patients had normal alanine transaminase (ALT) concentrations, while 14 patients' ALT concentrations remained elevated (median 140 units\/L) but were trending downward. Two patients (3.4%) developed hepatotoxicity (aspartate transaminase\/ALT &gt; 1000 units\/L). No patients developed hepatic failure, were listed for a liver transplant, were intubated, underwent hemodialysis, or died. Two patients (3.4%) developed anaphylactoid reactions. No known medication or administration errors occurred. Clinical outcome incidences of the studied endpoints with the alternative IV-NAC regimen are at the lower end of published incidence ranges compared to the FDA IV-NAC regimen for acetaminophen overdoses.<\/jats:p>\n        <jats:p>\n          <jats:bold>CONCLUSIONS:<\/jats:bold> This alternative IV-NAC regimen appears to be effective and well tolerated among pediatric patients when compared to the FDA-approved regimen. It may also result in fewer reconstitution and administration errors, leading to improved patient safety.<\/jats:p>","DOI":"10.5863\/1551-6776-20.3.178","type":"journal-article","created":{"date-parts":[[2020,10,27]],"date-time":"2020-10-27T19:48:24Z","timestamp":1603828104000},"page":"178-185","source":"Crossref","is-referenced-by-count":7,"title":["Evaluation of an Alternative Intravenous N-Acetylcysteine Regimen in Pediatric Patients"],"prefix":"10.5863","volume":"20","author":[{"given":"Kathryn A.","family":"Pauley","sequence":"first","affiliation":[{"name":"Department of Pharmacy, Children's Mercy Hospital, Kansas City, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tracy L.","family":"Sandritter","sequence":"additional","affiliation":[{"name":"Division of Clinical Pharmacology and Therapeutic Innovations, Children's Mercy Hospital, Kansas City, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer A.","family":"Lowry","sequence":"additional","affiliation":[{"name":"Division of Clinical Pharmacology and Therapeutic Innovations, Children's Mercy Hospital, Kansas City, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D. Adam","family":"Algren","sequence":"additional","affiliation":[{"name":"Division of Clinical Pharmacology and Therapeutic Innovations, Children's Mercy Hospital, Kansas City, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"3883","reference":[{"issue":"6","key":"i1551-6776-20-3-178-b1","series-title":"Pharmacoepidemiol Drug Saf","first-page":"398","article-title":"Estimates of acetaminophen-associated overdoses in the United States","volume":"15","year":"2006","unstructured":"Nourjah\n              P, \n            \n              Ahmad\n              SR, \n            \n              Karwoski\n              C, \n            \n              Willy\n              M.\n            \n          \n          Estimates of acetaminophen-associated overdoses in the United States. Pharmacoepidemiol Drug Saf. 2006;15(6):398\u2013405."},{"key":"i1551-6776-20-3-178-b2","series-title":"Acetadote (N-Acetylcysteine)","year":"2008","unstructured":"Product information\n          . Acetadote (N-Acetylcysteine). Nashville, TN: Cumberland Pharmaceuticals; 2008."},{"issue":"6","key":"i1551-6776-20-3-178-b3","series-title":"Ann Pharmacother","first-page":"766","article-title":"Frequency of medication errors with intravenous acetylcysteine for acetaminophen overdose","volume":"42","year":"2008","unstructured":"Hayes\n              BD, \n            \n              Klien-Schwarz\n              W, \n            \n              Doyon\n              S.\n            \n          \n          Frequency of medication errors with intravenous acetylcysteine for acetaminophen overdose. 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Br J Clin Pharmacol. 2001;52(5):573\u2013577."},{"issue":"6","key":"i1551-6776-20-3-178-b5","series-title":"Ann Pharmacother","first-page":"713","article-title":"Evaluation of a simplified n-acetylcysteine dosing regimen for the treatment of acetaminophen toxicity","volume":"45","year":"2011","unstructured":"Johnson\n              MT, \n            \n              McCammon\n              CA, \n            \n              Mullins\n              ME, \n            \n              Halcomb\n              SE.\n            \n          \n          Evaluation of a simplified n-acetylcysteine dosing regimen for the treatment of acetaminophen toxicity. 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Ther Adv Drug Saf. 2012;3(6):305\u2013315."},{"issue":"2","key":"i1551-6776-20-3-178-b10","series-title":"Clin Toxicol","first-page":"91","article-title":"Acetaminophen and acetylcysteine dose and duration: past, present, and future","volume":"50","year":"2012","unstructured":"Rumack\n              B, \n            \n              Bateman\n              DN.\n            \n          \n          Acetaminophen and acetylcysteine dose and duration: past, present, and future. Clin Toxicol. 2012;50(2):91\u201398."},{"issue":"2","key":"i1551-6776-20-3-178-b11","series-title":"Am J Ther","first-page":"e101","article-title":"Double peak and prolonged absorption after large acetaminophen extended-release and diphenhydramine ingestion","volume":"19","year":"2012","unstructured":"Burda\n              T, \n            \n              Sigg\n              T.\n            \n          \n          Double peak and prolonged absorption after large acetaminophen extended-release and diphenhydramine ingestion. Am J Ther. 2012;19(2):e101\u2013e104."},{"issue":"4","key":"i1551-6776-20-3-178-b12","series-title":"Pediatrics","first-page":"e1077","article-title":"Hepatic failure despite early acetylcysteine following large acetaminophen-diphenhydramine overdose","volume":"127","year":"2011","unstructured":"Wang\n              G, \n            \n              Monte\n              A, \n            \n              Bagdure\n              D, \n            \n              Heard\n              K.\n            \n          \n          Hepatic failure despite early acetylcysteine following large acetaminophen-diphenhydramine overdose. Pediatrics. 2011;127(4):e1077\u2013e1080."},{"issue":"1","key":"i1551-6776-20-3-178-b13","series-title":"Br J Clin Pharmacol","first-page":"87","article-title":"Risk factors in the development of adverse reactions to n-acetylcysteine in patients with paracetamol poisoning","volume":"51","year":"2005","unstructured":"Schmidt\n              LE, \n            \n              Dalhoff\n              K.\n            \n          \n          Risk factors in the development of adverse reactions to n-acetylcysteine in patients with paracetamol poisoning. Br J Clin Pharmacol. 2005;51(1):87\u201391."},{"issue":"6","key":"i1551-6776-20-3-178-b14","series-title":"Emerg Med J","first-page":"594","article-title":"Fatal anaphylactoid reaction to n-acetylcysteine: caution in patients with asthma","volume":"19","year":"2002","unstructured":"Appelboam\n              AV, \n            \n              Dargan\n              PI, \n            \n              Knighton\n              J.\n            \n          \n          Fatal anaphylactoid reaction to n-acetylcysteine: caution in patients with asthma. Emerg Med J. 2002;19(6):594\u2013595."},{"issue":"5","key":"i1551-6776-20-3-178-b15","series-title":"J Emerg Med","first-page":"607","article-title":"Safety and effectiveness of acetadote for acetaminophen toxicity","volume":"39","year":"2010","unstructured":"Whyte\n              AJ, \n            \n              Kehrl\n              T, \n            \n              Brooks\n              DE, \n            \n              Sokolowski\n              D.\n            \n          \n          Safety and effectiveness of acetadote for acetaminophen toxicity. J Emerg Med. 2010;39(5):607\u2013611."},{"issue":"1","key":"i1551-6776-20-3-178-b16","series-title":"J Pediatr","first-page":"149","article-title":"Efficacy of oral versus intravenous n-acetylcysteine in acetaminophen overdose: results of an open-label, clinical trial","volume":"132","year":"1998","unstructured":"Perry\n              HE, \n            \n              MW\n              Shannon\n            . \n          Efficacy of oral versus intravenous n-acetylcysteine in acetaminophen overdose: results of an open-label, clinical trial. 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Lancet. 1990;335(8705):1572\u20131573."},{"issue":"6","key":"i1551-6776-20-3-178-b22","series-title":"J Toxicol Clin Toxicol","first-page":"759","article-title":"Oral or intravenous n-acetylcysteine: which is the treatment of choice for acetaminophen (paracetamol) poisoning?","volume":"37","year":"1999","unstructured":"Buckley\n              NA, \n            \n              Whyte\n              IM, \n            \n              O'Connoll\n              DL, \n            \n              Dawson\n              AH.\n            \n          \n          Oral or intravenous n-acetylcysteine: which is the treatment of choice for acetaminophen (paracetamol) poisoning?\n          J Toxicol Clin Toxicol. 1999;37(6):759\u2013767."},{"issue":"5","key":"i1551-6776-20-3-178-b23","series-title":"Clin Toxicol (Phila)","first-page":"424","article-title":"A multi-center comparison of the safety of oral versus intravenous acetylcysteine for treatment of acetaminophen overdose","volume":"48","year":"2010","unstructured":"Bebarta\n              VS, \n            \n              Kao\n              L, \n            \n              Froberg\n              B, \n          \n          et al. A multi-center comparison of the safety of oral versus intravenous acetylcysteine for treatment of acetaminophen overdose. Clin Toxicol (Phila). 2010;48(5):424\u2013430."},{"issue":"3","key":"i1551-6776-20-3-178-b24","series-title":"Clin Liver Dis","first-page":"525","article-title":"Acetaminophen hepatotoxicity","volume":"11","year":"2007","unstructured":"Larson\n              AM.\n            \n          \n          Acetaminophen hepatotoxicity. Clin Liver Dis. 2007;11(3):525\u2013548."},{"issue":"10","key":"i1551-6776-20-3-178-b25","series-title":"Curr Med Res Opin","first-page":"2359","article-title":"Safety and efficacy of intravenous n-acetylcysteine for acetaminophen overdose: analysis of the Hunter Area Toxicology Service (HATS) database","volume":"23","year":"2007","unstructured":"Whyte\n              IM, \n            \n              Francis\n              B, \n            \n              Dawson\n              AH.\n            \n          \n          Safety and efficacy of intravenous n-acetylcysteine for acetaminophen overdose: analysis of the Hunter Area Toxicology Service (HATS) database. Curr Med Res Opin. 2007;23(10):2359\u20132368."},{"issue":"4","key":"i1551-6776-20-3-178-b26","series-title":"Arch Pediatr Adolesc Med","first-page":"346","article-title":"Pediatric acetaminophen overdose: risk factors associated with hepatocellular injury","volume":"154","year":"2000","unstructured":"Alander\n              SW, \n            \n              Dowd\n              MD, \n            \n              Bratton\n              SL, \n            \n              Kearns\n              GL.\n            \n          \n          Pediatric acetaminophen overdose: risk factors associated with hepatocellular injury. Arch Pediatr Adolesc Med. 2000;154(4):346\u2013350."},{"issue":"2","key":"i1551-6776-20-3-178-b27","series-title":"Clin Toxicol (Phila)","first-page":"111","article-title":"Paracetamol (acetaminophen) attenuates in vitro mast cell and peripheral blood mononucleocyte cell histamine release induced by n-acetylcysteine","volume":"48","year":"2010","unstructured":"Coulson\n              J, \n            \n              Thompson\n              JP.\n            \n          \n          Paracetamol (acetaminophen) attenuates in vitro mast cell and peripheral blood mononucleocyte cell histamine release induced by n-acetylcysteine. Clin Toxicol (Phila). 2010;48(2):111\u2013114."}],"container-title":["The Journal of Pediatric Pharmacology and Therapeutics"],"original-title":[],"link":[{"URL":"https:\/\/jppt.kglmeridian.com\/view\/journals\/jppt\/20\/3\/article-p178.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/meridian.allenpress.com\/jppt\/article-pdf\/20\/3\/178\/1786444\/1551-6776-20_3_178.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/jppt.kglmeridian.com\/downloadpdf\/journals\/jppt\/20\/3\/article-p178.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/jppt.kglmeridian.com\/downloadpdf\/journals\/jppt\/20\/3\/article-p178.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,16]],"date-time":"2025-05-16T00:37:18Z","timestamp":1747355838000},"score":1,"resource":{"primary":{"URL":"https:\/\/jppt.kglmeridian.com\/view\/journals\/jppt\/20\/3\/article-p178.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015]]},"references-count":27,"journal-issue":{"issue":"3"},"URL":"https:\/\/doi.org\/10.5863\/1551-6776-20.3.178","relation":{},"ISSN":["1551-6776"],"issn-type":[{"value":"1551-6776","type":"print"}],"subject":[],"published":{"date-parts":[[2015]]}}}