The traditional three bag protocol is associated with a high rate of adverse reactions, ranging from mild to severe. It is almost completely protective against deaths secondary to paracetamol-induced liver injury when administered within 8 hours of ingestion. Traditionally acetylcysteine is given over a series of three infusions given over 20 hours. Acetylcysteine also supplies thiol groups, which can directly bind with NAPQI in hepatocytes and enhances non-toxic sulfate conjugation. Acetylcysteine is a cysteine precursor, it is hydrolysed intracellularly to cysteine, which replenishes glutathione. Glutathione is essential in the metabolism of NAPQI (toxic paracetamol metabolite. Its efficacy as a specific antidote for paracetamol poisoning relies mainly on its ability to stimulate glutathione synthesis. Guest Post – Dr Angela Chiew – Australian Clinical Toxicologist and Emergency Staff SpecialistĪcetylcysteine is the most widely used antidote for paracetamol poisoning.
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