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Use of activated charcoal in a simulated poisoning with acetaminophen : a new loading dose for N-acetylcysteine ? 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 .
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Intervention_Pharmacological
N-acetylcysteine
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Intervention_Pharmacological
N-acetylcysteine
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Intervention_Pharmacological
acetaminophen
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Intervention_Pharmacological
N-acetylcysteine
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Intervention_Pharmacological
3 g acetaminophen
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Intervention_Pharmacological
60 g activated charcoal and a supranormal loading dose of N-acetylcysteine
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Intervention_Pharmacological
N-acetylcysteine
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Intervention_Pharmacological
N-acetylcysteine
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Intervention_Pharmacological
N-acetylcysteine
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Intervention_Pharmacological
N-acetylcysteine
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Intervention_Pharmacological
N-acetylcysteine
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Outcome_Physical
Serum levels of N-acetylcysteine
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Outcome_Physical
serum acetaminophen level
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Outcome_Physical
Peak N-acetylcysteine
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Outcome_Physical
time to peak
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Outcome_Physical
four-hour serum acetaminophen level
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Outcome_Adverse-effects
Diarrhea
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Outcome_Other
tolerated
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Participant_Condition
poisoning with acetaminophen
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Participant_Sample-size
Ten
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Participant_Age
adult volunteers
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Participant_Condition
acetaminophen overdose