How is acetaminophen toxicity treated in patients with acute liver failure (ALF)?

Updated: Jun 13, 2019
  • Author: Gagan K Sood, MD; Chief Editor: BS Anand, MD  more...
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Treat acetaminophen (paracetamol, APAP) overdose with N-acetylcysteine (NAC). [44] Researchers theorize that this antidote works by a number of protective mechanisms. Early after an overdose, NAC prevents the formation and accumulation of N-acetyl-p-benzoquinone imine (NAPQI), a free radical that binds to intracellular proteins, nonspecifically resulting in toxicity.

NAC increases glutathione stores, combines directly with NAPQI as a glutathione substitute, and enhances sulfate conjugation. NAC also functions as an anti-inflammatory and antioxidant and has positive inotropic and vasodilating effects, which improve the microcirculatory blood flow and oxygen delivery to tissues. These latter effects decrease morbidity and mortality once hepatotoxicity is well established.

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