N-acetyl Cysteine (Mucomyst)
                ============================
þ  oral NAC protocol:
 - 17 oral doses over 72 hours
 - 140 mg/kg loading
 - 70 mg/kg Q4H (total 1330 mg/kg)
 - if giving charcoal:  increase loading dose to 230 mg/kg _OR_, give another
   140 mg rather than 70 mg dose. [Roberts J. Acetaminophen overdose:
   laboratory evaluation and gastric decontamination issues. Emerg Med News.]
 - giving Reglan (metaclopramide) 20 mg IV helps prevent vomiting when giving
   Mucomyst [Roberts, Ibid.]
 - may improve outcome even with established liver failure up to 36 hours
   after ingestion
   [Harrison PM et al. Improved outcome of paracetamol-induced
   fulminant hepatic failure by late administration of acetylcysteine. Lancet
   1990;335:1572 et seq.]

þ Prescott (British) protocol:
 - 20 hours
 - 150 mg/kg IV over 15 minutes
 - 50 mg/kg over four hours
 - 100 mg/kg over 16 hours (total 300 mg/kg)
 - OK to stop NAC @20 hours if 24-hour labs normal:
  + negative acetaminophen
  + normal LFTs
  + normal PT
 - if LFTs elevated, continue
 - numbers as good or better than the 48-hour regimen or the 72-hour oral
   regime


þ Smilkstein protocol:
 - 48 hours
 - 140 mg/kg IV
 - 12 doses of 70 mg/kg (total 980 mg/kg)

þ IV Mucomyst
  <P-Tyl-IV.TXT>

þ Pathophysiology
 - precursor to glutathione
 - detoxifies NAPQI (toxic metabolite of acetaminophen) which is then excreted