Article Instance
API Endpoint for journals.
GET /api/articles/17554/?format=api
{ "pk": 17554, "title": "Is Two Better Than Three? A Systematic Review of Two-bag Intravenous N-acetylcysteine Regimens for Acetaminophen Poisoning", "subtitle": null, "abstract": "Introduction\n: Acetaminophen poisoning is commonly treated by emergency physicians. First-line therapy is N-acetylcysteine (NAC), traditionally administered intravenously via a US Food and Drug Administration (FDA)-approved three-bag protocol in which each bag has a unique concentration and infusion duration. Recently, simplified, off-label two-bag NAC infusion protocols have become more common. The purpose of this review is to summarize the effectiveness and safety of two-bag NAC.\nMethods:\n We undertook a comprehensive search of PubMed, EMBASE, and MEDLINE from inception to December 13, 2022, for articles describing human acetaminophen poisonings treated with two-bag NAC, defined as any regimen involving two discrete infusions in two separate bags. Outcomes included effectiveness (measured by incidence of liver injury); incidence of non-allergic anaphylactoid reactions (NAAR); gastrointestinal, cutaneous, and systemic reactions; treatments for NAARs; incidence of NAC-related medication errors; and delays or interruptions in NAC administration.\nResults: \nTwelve articles met final inclusion, 10 of which compared two-bag NAC to the three-bag regimen. Nine articles evaluated the two-bag/20-hour regimen, a simplified version of the FDA-approved three-bag regimen in which the traditional first and second bags are combined into a single four-hour infusion. Nine articles assessed comparative effectiveness of two-bag NAC in terms of liver injury, most commonly assessed for by incidence of hepatotoxicity (aspartate aminotransferase or alanine aminotransferase >1,000 international units per liter). No difference in liver injury was observed between two-bag and three-bag regimens. Of nine articles comparing incidence of NAARs, eight demonstrated statistically fewer NAARs with two-bag regimens, and one showed no difference. In seven articles evaluating treatment for NAARs (antihistamines, corticosteroids, epinephrine), all showed that patients received fewer medications for NAARs with two-bag NAC. Three articles evaluated NAC-related medication errors; two demonstrated no difference, while one study evaluating only children showed fewer errors with two-bag NAC. Two studies evaluated delays and/or interruptions in NAC infusions; both favored two-bag NAC.\nConclusion:\n For patients with acetaminophen poisoning, two-bag NAC regimens appear to have similar outcomes to the traditional three-bag regimen in terms of liver injury. Two-bag NAC regimens are associated with fewer adverse events and fewer treatments for those events than the three-bag regimen and fewer interruptions in antidotal therapy.", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [ { "word": "Acetaminophen" }, { "word": "acetylcysteine" }, { "word": "antidotes" }, { "word": "poisoning" }, { "word": "drug overdose" }, { "word": "Poison control centers" } ], "section": "Toxicology", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/15z8n18j", "frozenauthors": [ { "first_name": "Jon", "middle_name": "B.", "last_name": "Cole", "name_suffix": "", "institution": "Hennepin Healthcare, Department of Emergency Medicine, Minneapolis, Minnesota; University of Minnesota Medical School, Department of Emergency Medicine, Minneapolis, Minnesota; Minnesota Poison Control System, Minneapolis, Minnesota", "department": "None" }, { "first_name": "Carrie", "middle_name": "L.", "last_name": "Oakland", "name_suffix": "", "institution": "Minnesota Poison Control System, Minneapolis, Minnesota", "department": "None" }, { "first_name": "Samantha", "middle_name": "C.", "last_name": "Lee", "name_suffix": "", "institution": "Minnesota Poison Control System, Minneapolis, Minnesota", "department": "None" }, { "first_name": "Kelly", "middle_name": "A.", "last_name": "Considine", "name_suffix": "", "institution": "Hennepin Healthcare, Medical Intensive Care Unit, Department of Pharmacy, Minneapolis, Minnesota", "department": "None" }, { "first_name": "Maria", "middle_name": "I.", "last_name": "Rudis", "name_suffix": "", "institution": "Mayo Clinic, Department of Pharmacy, Rochester, Minnesota; Mayo Clinic, Department of Emergency Medicine, Rochester, Minnesota", "department": "None" }, { "first_name": "Alison", "middle_name": "L.", "last_name": "Swanson", "name_suffix": "", "institution": "Children’s Hospitals and Clinics of Minnesota, Department of Pharmacy, Minneapolis, Minnesota", "department": "None" }, { "first_name": "Travis", "middle_name": "D.", "last_name": "Olives", "name_suffix": "", "institution": "Hennepin Healthcare, Department of Emergency Medicine, Minneapolis, Minnesota; University of Minnesota Medical School, Department of Emergency Medicine, Minneapolis, Minnesota; Minnesota Poison Control System, Minneapolis, Minnesota", "department": "None" } ], "date_submitted": "2022-10-04T23:39:53Z", "date_accepted": "2022-10-04T23:39:53Z", "date_published": "2023-09-25T19:20:33Z", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/17554/galley/8951/download/" } ] }