1.
Early presentation following overdose of modified-release paracetamol (Panadol Osteo) with biphasic and prolonged paracetamol absorption.
Graudins, A, Pham, HN, Salonikas, C, Naidoo, D, Chan, B
The New Zealand medical journal. 2009;(1300):64-71
Abstract
BACKGROUND Panadol Osteo (GlaxoSmithKline) is a modified-release paracetamol formulation marketed in Australia and New Zealand, comprising 33% immediate and 66% sustained-release fractions. In overdose, absorption may be delayed and the paracetamol treatment nomogram can miss potentially toxic paracetamol concentrations if only one serum estimate is taken. We report a massive ingestion of Panadol Osteo with biphasic, prolonged absorption requiring extended treatment with N-acetylcysteine. CASE REPORT A 72-year-old female presented 2 hours after ingesting 119x665 mg (1 g/kg) of Panadol Osteo and 5x30 mg mirtazepine. The patient was drowsy (GCS14). Activated charcoal was not administered. Her pulse was 70 bpm, BP 149/63 mmHg with an unremarkable physical examination. Two-hour paracetamol concentration was 2628 micromol/L falling to 2216 micromol/L, 4 hours post-ingestion. Admission acid-base status and liver function were normal. N-acetylcysteine was commenced using the standard 21-hour intravenous protocol and continued for 5 days (total dose 700 mg/kg) until paracetamol concentrations were undetectable. Serum paracetamol peaked a second time, 12 hours post-ingestion, at 3040 micromol/L and paracetamol absorption continued for 35 hours post-ingestion. Despite early administration of N-acetylcysteine, serum AST/ALT peaked at 384 and 541 IU/L on day 3 with normal coagulation profile. CONCLUSIONS Massive ingestion of modified-release paracetamol (Panadol Osteo) may result in biphasic and prolonged paracetamol absorption requiring extended administration of N-acetylcysteine. Current intravenous dosing regimens may not provide enough N-acetylcysteine to effectively metabolise paracetamol to non-toxic adducts.
2.
A case of haemodialysis-associated pseudoporphyria successfully treated with oral N-acetylcysteine.
Cooke, NS, McKenna, K
Clinical and experimental dermatology. 2007;(1):64-6
Abstract
We report a 33-year-old woman with haemodialysis-associated pseudoporphyria successfully responding to treatment with oral N-acetylcysteine. We briefly review the current literature on bullous skin disorders in end-stage renal disease, and compare and contrast the pathogenesis of pseudoporphyria and porphyria cutanea tarda in this context. We also discuss the antioxidant properties and clinical applications of N-acetylcysteine, including the treatment of haemodialysis-associated pseudoporphyria.
3.
The critically ill liver patient: fulminant hepatic failure.
McGuire, BM
Seminars in gastrointestinal disease. 2003;(1):39-42
Abstract
Fulminant hepatic failure is a challenging medical condition that requires intensive care management to prevent-major complications (cerebral edema, infections, and multi-system organ failure) and assistance from a liver transplant team when it is believed that liver regeneration is unlikely. Unfortunately, there are no specific medical therapies or devices to correct all of the functions of a liver. N-acetylcysteine is used for the treatment of acetaminophen overdose, but for most other causes of fulminant hepatic failure therapy is supportive care. This case illustrates many of the problems that are encountered during medical management of fulminant hepatic failure.
4.
Radical scavengers for Ménière's disease after failure of conventional therapy: a pilot study.
Takumida, M, Anniko, M, Ohtani, M
Acta oto-laryngologica. 2003;(6):697-703
Abstract
OBJECTIVE To perform a trial to assess the efficacy of radical scavengers, i.e. rebamipide, vitamin C and glutathione, for the treatment of Ménière's disease (MD). MATERIAL AND METHODS Rebamipide (300 mg/day), vitamin C (600 mg/day) and/or glutathione (300 mg/day) were given orally for at least 8 weeks to 25 patients with poorly controlled MD. RESULTS Of 22 patients, 21 showed marked improvement of vertigo; 12/27 ears showed improvement of hearing disorders; 17/27 ears showed improvement of tinnitus; and 18/25 patients showed improvement of disability. CONCLUSION This study suggests that treatment using radical scavengers has the potential to become an effective new therapy for MD.