Use of activated charcoal in a simulated poisoning with acetaminophen: A new loading dose for N-acetylcysteine?

James M. Chamberlain, Richard L. Gorman, Gary M. Oderda, Wendy Klein-Schwartz, Bruce L. Klein

Research output: Contribution to journalArticlepeer-review

Abstract

Study objectives: To investigate the ability of a supranormal dose of N-acetylcysteine to overcome the effects of activated charcoal on N-acetylcysteine bioavailability and to determine the effects of activated charcoal on serum acetaminophen levels. Design, setting, and participants: Ten healthy adult volunteers participated in a controlled cross-over experiment. During phase I (control), subjects ingested 3 g acetaminophen, followed one hour later by the normal loading dose of N-acetylcysteine (140 mg/kg). During phase II (charcoal), subjects ingested 3 g acetaminophen, followed one hour later by 60 g activated charcoal and a supranormal loading dose of N-acetylcysteine (235 mg/kg). Main outcome measures: Serum levels of N-acetylcysteine were measured every 30 minutes for six hours. A serum acetaminophen level was measured at four hours. Results: The area under the curve for N-acetylcysteine was significantly higher for phase II than phase I (P < .05), two-tailed paired t-test). Peak N-acetylcysteine and time to peak were not significantly different. The four-hour serum acetaminophen level was significantly lower for phase II than phase I (P < .05, two-tailed paired t-test). Diarrhea occurred during both phases, but N-acetylcysteine was otherwise well tolerated. Conclusion: These results suggest that activated charcoal can be used safely for victims of acetaminophen overdose. A beneficial effect in preventing acetaminophen absorption can be expected if it is given within one hour after ingestion. If N-acetylcysteine is needed because of a toxic serum acetaminophen level, bioavailability can be ensured by increasing the N-acetylcysteine loading dose from 140 mg/kg to 235 mg/kg.

Original languageEnglish (US)
Pages (from-to)1398-1402
Number of pages5
JournalAnnals of emergency medicine
Volume22
Issue number9
DOIs
StatePublished - Sep 1993
Externally publishedYes

Keywords

  • N-acetylcysteine
  • activated charcoal

ASJC Scopus subject areas

  • Emergency Medicine

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