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Acetaminophen overdose is a relatively common cause of acute drug-induced liver injury. Early administration of N-acetylcysteine (NAC) within 8 hours of acute acetaminophen overdose universally prevents hepatotoxicity. A fixed dosage of 300 mg/kg given over 20–72 hours was arbitrarily defined, and shorter duration of therapy may be possible in selected low-risk groups.
In a multicenter, open-label trial in Australia, 100 patients presenting to emergency departments with acute acetaminophen overdose and normal alanine transaminase (ALT) and creatinine levels were randomized to 250 mg/kg of NAC for 12 hours or 300 mg/kg for 20 hours (control group). In the intervention group, if the acetaminophen level was <20 mg/L and ALT and creatinine level…