Methods
In approaching this topic, a search of PubMed was done using index
terms: paracetamol; acetylcysteine; dose; toxicity; massive paracetamol
overdose.
Of the many thousand references identified the author has manually
chosen those that specifically deal with the areas to be covered in this
discussion and identified references also using a large personal
collection that are relevant.
A focus on the 3 areas most apposite to the issue of increasing doses of
NAC in large paracetamol overdose has been adopted, these being evidence
that:-
- larger doses of paracetamol cause increased toxicity even with
NAC therapy
- increasing NAC dose may have efficacy in large paracetamol
overdoses
- the various modes of action suggested for NAC that may be
relevant to any increased efficacy from a larger NAC dose.