St Emlyn´s - Posted by Simon Carley
"The week’s Lancet has a great paper on the management of paracetamol overdose. A subject close to our heart at St.Emlyn’s following the recent changes to UK guidelines that have led far more people in the ‘treatment zone’. The increase in the number of patients getting treatment has inevitably led to an increase in the number of patients suffering the side effects of treatment."
http://stemlynsblog.org/jc-double-speed-parvolex-paracetamol-od-st-emlyns/
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The Lancet
Bateman D y col. Lancet 2014; 383: 697–704
"Interpretation: We have shown in our study that a 12 h intravenous regimen of acetylcysteine, with an initial loading dose over 2 h, is effective at reducing the incidence of vomiting and anaphylactoid reactions, compared with the standard 20·25 h intravenous acetylcysteine schedule. Our trial was not powered to assess non-inferiority of the modifi ed protocol, but no difference in effi cacy was recorded between groups. Ondansetron pretreatment was effective at reducing vomiting but had no eff ect on anaphylactoid reactions and was associated with a rise in the amount of aminotransferase. Other key advantages of the 12h regimen include simplicity and substantial reductions in the need to treat anaphylactoid reactions and to interrupt the acetylcysteine infusion because of adverse effects, both of which complicate and prolong hospital care. This shorter and simpler protocol, if proven to be non-inferior to the conventional acetylcysteine regimen, has considerable potential to reduce adverse eff ects and length of hospital stay in patients requiring acetylcysteine treatment after a paracetamol overdose."
http://download.thelancet.com/pdfs/journals/lancet/PIIS0140673613620620.pdf?id=eaa6SC6gcGJkFbRdzpVru