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Previous Volume 359:1962-1965 October 30, 2008 Number 18 Next

	Since this article has no abstract, we have provided an extract of the first 100 words of the full text and any section headings.

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To the Editor: Heard (July 17 issue)¹ reports that acetylcysteine reduces the severity of acetaminophen poisoning–induced liver damage by restoring the hepatic glutathione pool. However, one major concern not mentioned in the article is the possible decrease in the prothrombin index (defined in the legend to Figure 1), a prognostic indicator of hepatotoxicity.

Acetylcysteine may significantly reduce the prothrombin index in the absence of liver or clotting abnormalities.^2,3 In an 8-year retrospective analysis, we treated 171 patients who had acetaminophen poisoning with intravenous acetylcysteine according to the recommendations outlined in Heard's article. Among 115 patients without underlying or acute liver . . . [Full Text of this Article]

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