![]() ![]() Discussion: This study is the first attempt to formally examine new methods of administering IV NAC in patients with paracetamol overdose. Where clinically necessary, further doses of NAC were administered as per standard UK protocols at the end of the first antidote course. In addition the frequency of anaphylactoid reactions was documented, and end of treatment liver function assessed. The primary outcome was the incidence of nausea and vomiting following NAC. Patients were stratified on paracetamol dose, perceived risk factors, and time to presentation, and randomisation performed to balance entry into the four trial groups. Each regimen delivered a total dose of 300 mg/kg bodyweight NAC. Here, we compared pre-treatment with ondansetron 4 mg intravenously against placebo on nausea and vomiting following the standard (20.25 hour) regimen of NAC, or a novel 12 h regimen, in patients with paracetamol poisoning. Methods/Design: We designed a double blind clinical trial using a 2 x 2 factorial design involving four parallel groups. We therefore designed a randomised controlled study investigating the efficacy of antiemetic pre-treatment (ondansetron) using standard and modified regimens of NAC. A simpler, shorter regimen has the potential to improve patient safety and reduce hospital length of stay. Recognised complications include a high incidence of nausea and vomiting, anaphylactoid reactions and dosing errors. The same weight-related dose of NAC is used in all patients irrespective of paracetamol dose. This antidotal therapy involves three different infusion regimens (dose and time) of antidote and lasts over 20 hours. An effective antidote, acetylcysteine (NAC) was introduced in the 1970s and the intravenous (IV) regimen introduced at that time has continued effectively unchanged since. Lookup NU author(s): Dr Harry Thanacoody,īackground: Paracetamol (acetaminophen) poisoning remains the commonest cause of acute liver injury in Europe and North America. Scottish and Newcastle Antiemetic Pre-treatment for paracetamol poisoning study (SNAP)
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