To the Editor: In his otherwise excellent review of drug-inducedliver injury, Lee asserts that N-acetylcysteine reliably preventsliver injury if treatment is begun within 12 to 24 hours afterthe ingestion of acetaminophen. This is incorrect.
N-acetylcysteine is almost universally effective when givenwithin 8 to 10 hours after an acute overdose of acetaminophen,but its antidotal efficacy decreases substantially thereafter.1,2Most patients presenting after a delay should still receivethe antidote,1,3 but clinicians should remain vigilant for evidenceof acute liver failure in such cases.
David N. Juurlink, M.D., Ph.D. University of Toronto Toronto, ON M4N . . . [Full Text of this Article]
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