![]() ![]() These mechanistic findings, together with the excellent safety profile after methanol and ethylene glycol poisoning and after an APAP overdose, suggest that fomepizole may be a promising antidote against APAP overdose that could be useful as adjunct treatment to NAC. Furthermore, the formation of oxidative metabolites was eliminated in healthy volunteers using the established treatment protocol for fomepizole in toxic alcohol and ethylene glycol poisoning. These mechanisms of protection (inhibition of Cyp2E1 and JNK) and an extended efficacy compared to NAC could be verified in primary human hepatocytes. In addition, fomepizole treatment, unlike NAC, prevented APAP-induced kidney damage and promoted hepatic regeneration in mice. In animal studies, fomepizole effectively prevented APAP-induced liver injury by inhibiting Cyp2E1 when treated early, and by inhibiting c-jun N-terminal kinase (JNK) and oxidant stress when treated after the metabolism phase. Fomepizole (4-methylpyrazole), a clinically approved antidote against methanol and ethylene glycol poisoning, recently emerged as a promising candidate. Thus, additional antidotes with an extended therapeutic window may be needed for these patients. However, for late-presenting patients or after ingestion of very large overdoses, the efficacy of NAC is diminished. ![]() The standard oral or intravenous dosing regimen of NAC is highly effective for patients with moderate overdoses who present within 8 h of APAP ingestion. N-acetylcysteine (NAC) is still the only FDA-approved antidote against APAP overdose 40 years after its introduction. Also it is important to carry out the administration phases and check the patient’s symptoms more attentively and cautiously.Acetaminophen (APAP) overdose can cause hepatotoxicity and even liver failure. Considering the possible errors in the prescription and administration of some critical and less commonly used drugs especially those which have several different formulary and also considering their possible serious and life threatening side effects, it is recommended that the dose and volume of such medications be calculated meticulously by at least two trained persons. Immediately the patient became drowsy and developed decreased level of consciousness, stupor, repetitive intractable focal and generalized convulsions, decrease visual acuity and had prolonged hospitalization in intensive care unit and pediatric neurologic wards and perhaps will have permanent subtle intellectual and neurologic sequela. The Physician prescribed 2 grams of intravenous NAC for him, but because of the miscalculation of the volume of the drug, the nurse infused about 20 grams of NAC (10 times the prescribed dose) to the patient. Here we report a rare case of iatrogenic NAC overdose following an error in calculation of the prescribed dose.The patient was a 2.5 years old boy that was brought to emergency room with overdose of acetaminophen syrup. There is always a risk of iatrogenic overdose of NAC which can cause different mild to severe temporary or permanent side effects, some of which can be life threatening. In children considering the toxic dose of acetaminophen ingested by the patient and the body weight, the physician prescribes a specific dose of NAC. N-acetylcysteine (NAC) is a drug used widely and effectively in oral and intravenous forms as a specific antidote for acetaminophen poisoning.
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