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The standard approach to acetaminophen poisoning is an 18-dose oral regimen of N-acetylcysteine given over 72 hours. However, this regimen may prolong an otherwise short hospitalization, and the bad taste of N-acetylcysteine sometimes causes nausea or vomiting.
In a prospective study, researchers from the California poison control system tested a shortened protocol for patients with potentially toxic acetaminophen ingestion. After the initial five doses of N-acetylcysteine (20 hours), the drug could be stopped if the acetaminophen level was undetectable and the AST, ALT, and prothrombin times were normal. If any of these conditions were not met, N-acetylcysteine was continued until the acetaminophen level was undetectable and the lab tests w…