Summary

Paracetamol poisoning: a prospective comparison of 2 protocols for N-acetylcysteine treatment

August Supervía1-3, M.ª Àngels Gispert3,4, Jordi Puiguriguer5, Pablo Borja Álvarez Zabala6, Lidia Martínez Sánchez3,7,8, Samuel Olmos3,9, Beatriz Calderón10, Rocío de Paz Picornell1, Santiago Nogué3,11, Francisca Córdoba3,12

Affiliation of the authors

1Servicio de Urgencias, Hospital Universitario del Mar, Barcelona, Spain. 2Unitat Funcional de Toxicología, Hospital Universitario del Mar, Barcelona, Spain. 3Grup de treball de Toxicologia de la SoCMUE (SoCMUETox). 4Servicio de Urgencias, Hospital Dr. Josep Trueta, Girona, Spain. 5Servicio de Urgencias, Hospital Son Espases, Palma de Mallorca, Spain. 6Servicio de Pediatría, Hospital Sant Joan de Déu, Barcelona, Spain. 7Servicio de Urgencias de Pediatría, Hospital Sant Joan de Déu, Barcelona, Spain. 8Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain. 9Servicio de Urgencias, Consorci Sanitari Parc Taulí, Sabadell, Barcelona, Spain. 10Servicio de Urgencias, Hospital Son Llàtzer, Palma de Mallorca, Spain. 11Fundación Española de Toxicología Clínica. 12Servicio de Urgencias, Hospital Moisès Broggi Sant Joan Despí, Barcelona, Spain.

DOI

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Supervía A, Gispert M,A, Puiguriguer J, Álvarez Zabala PB, Martínez Sánchez L, Olmos S, et al. Paracetamol poisoning: a prospective comparison of 2 protocols for N-acetylcysteine treatment. Emergencias. 2025;37:39-43

Summary

Background and objective.

Paracetamol poisoning can be serious and require treatment with N-acetylcysteine (NAC). A dose of 300 mg/kg is usually given in 3 fractions over 21 hours. An alternative regimen, the Scottish and Newcastle Acetylcysteine Protocol (SNAP), specifies the same total dose given in 2 intravenous injections over 12 hours. This study aimed to compare the 2 regimens in terms of effectiveness, adverse events, and lengths of emergency department (ED) and hospital stays.

Methods.

Prospective multicenter study to compare outcomes associated with the traditional NAC regimen vs SNAP. We enrolled all patients with paracetamol poisoning requiring NAC treatment in the participating hospital EDs from 2021 through 2023. Data related to referrals, poisoning episodes, and discharge destinations were collected. Patients were studied in 2 groups according to the protocol assigned in the EDs.

Results.

A total of 165 patients were treated (SNAP, 103; traditional protocol, 62). The mean (SD) age was 28.1 (19.7) years, and most were female (70.5%). No differences in peak transaminase levels were observed. SNAP-treated patients had significantly fewer adverse effects as well as shorter stays both in the ED (17.8 [15.2] hours vs 25.9 [17.1] hours; P = .001) and on the ward (2.6 [2.3] days vs 4.4 [3.6] days; P = .019).

Conclusions.

Fewer adverse events occurred with the SNAP approach. The 2 protocols were similarly effective. The SNAP-treated patients spent less time in the ED, and those who were admitted to hospital had shorter stays.

 

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