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Journal of The Korean Society of Emergency Medicine 2005;16(2): 281-286. |
| N-acetylcysteine for Acetaminophen Poisoning Without Hepatotoxicity: the Effect on the Prothrombin Time |
| Won Jae Lee, Kyu Nam Park, Seung Pil Choi, Mi Jin Lee, Jung Hee Wee, Byung Hak So |
| Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea. emmam@catholic.ac.kr |
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| ABSTRACT |
PURPOSE:
In patients with acetaminophen poisoning, clinical severities are partly based on the prothrombin time. In several conditions, N-acetylcysteine (NAC) infusion has been shown to lower the prothrombin index. Thus, we studied the effect of NAC on the prothrombin time in patients intoxicated with acetaminophen without hepatotoxicity.
METHODS:
From March 2000 to Aug 2004, we reviewed the medical records of 149 patients with a diagnosis of acetaminophen poisoning. After 88 patients had been excluded (29 had hepatocellular injury, 14 had a probable risk based on their normogram, and 45 had a missing prothrombin index value), 61 patients were included in the analysis. The prothrombin time was recorded before and serially during NAC treatment.
RESULTS:
The mean baseline prothrombin time was 99.1%, 99.3% after intravenous NAC infusion, and 74.0% at 8 hrs after initiation of NAC infusion. It decreased rapidly at 16 hrs, and reached a steady baseline state between 16 to 24 hrs. A rapid increase in the baseline time occurred after 2-3 days when the NAC infusion was stopped. After oral NAC treatment, it decreased rapidly from 8 to 16 hrs, and reached a steady baseline after 2 days. There was a rapid increase after 3~4 days when the NAC infusion was stopped.
CONCLUSION:
In patients with uncomplicated acetaminophen poisoning, the decrease in the prothrombin index might be misinterpreted as a sign of liver failure, leading to a prolonged treatment. |
| Key words:
Acetaminophen, Poisoning, N-acetylcysteine, Prothrombin time |
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