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Clinical outcomes in patients with paracetamol ingestion treated with a two-bag n-acetylcysteine regimen in the emergency centre of khayelitsha hospital
Introduction: Paracetamol is frequently ingested for intentional self-poisoning. N-acetylcysteine (NAC) is administered to patients at risk of developing hepatotoxicity and was historically administered using a three-bag intravenous regimen. A change towards a two-bag NAC regimen was initiated at Kh...
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| Format: | Thesis |
| Language: | Eng |
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Division of General Surgery
2024
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| _version_ | 1867613366627860480 |
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| access_status_str | Open Access |
| author | Mbanga, Kedibone |
| author2 | Khan, Waseela |
| author_browse | Khan, Waseela Mbanga, Kedibone |
| author_facet | Khan, Waseela Mbanga, Kedibone |
| author_sort | Mbanga, Kedibone |
| collection | Thesis |
| description | Introduction: Paracetamol is frequently ingested for intentional self-poisoning. N-acetylcysteine (NAC) is administered to patients at risk of developing hepatotoxicity and was historically administered using a three-bag intravenous regimen. A change towards a two-bag NAC regimen was initiated at Khayelitsha Hospital. The aim of the study was to describe the clinical outcomes in patients with a history of paracetamol ingestion who were treated with the two-bag NAC regimen. A descriptive comparison to a historical cohort of patients treated with the three-bag NAC regimen was also made. Methods: A retrospective chart review was conducted to assess a 6-month clinical audit. Summary statistics were used to describe all variables. Results: Overall, 57 patients were included (mean age 26 years, 83% female). The median ingested dose (10 g) was similar between the regimens. An empiric indication occurred more in patients receiving the two-bag regimen (84.0% versus 50.0%). The median paracetamol level (231 umol/L) and the proportion of confirmed paracetamol toxicity (32%) were less in the two-bag regimen. A delay in initiating the first NAC infusion occurred in 22 (38.6%) patients. Forty adverse effects were recorded in 22 (38.6%) patients and a higher proportion occurred in the two-bag regime (44.0% vs. 34.4%). Nausea and vomiting occurred frequently (n=30, 52.7%), which were comparable for both regimens. The prevalence of hepatotoxicity after receiving NAC was 8.8% (n=5). Conclusion: A large number of patients were empirically started on NAC with a higher incidence of adverse reactions in the two-bag NAC than in the three-bag NAC regimen in contrast to existing evidence. However, there was a reduction in treatment delay in the two-bag NAC regimen compared to the three-bag NAC regimen. |
| format | Thesis |
| id | oai:open.uct.ac.za:11427/40563 |
| institution | University of Cape Town (South Africa) |
| language | Eng |
| last_indexed | 2026-06-10T12:35:00.730Z |
| license_str | Not specified — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from UCTD — University of Cape Town Open Access Repository |
| publishDate | 2024 |
| publishDateRange | 2024 |
| publishDateSort | 2024 |
| publisher | Division of General Surgery |
| publisherStr | Division of General Surgery |
| record_format | dspace |
| source_str | UCTD — University of Cape Town Open Access Repository |
| spelling | oai:open.uct.ac.za:11427/40563 Clinical outcomes in patients with paracetamol ingestion treated with a two-bag n-acetylcysteine regimen in the emergency centre of khayelitsha hospital Mbanga, Kedibone Khan, Waseela General Surgery Introduction: Paracetamol is frequently ingested for intentional self-poisoning. N-acetylcysteine (NAC) is administered to patients at risk of developing hepatotoxicity and was historically administered using a three-bag intravenous regimen. A change towards a two-bag NAC regimen was initiated at Khayelitsha Hospital. The aim of the study was to describe the clinical outcomes in patients with a history of paracetamol ingestion who were treated with the two-bag NAC regimen. A descriptive comparison to a historical cohort of patients treated with the three-bag NAC regimen was also made. Methods: A retrospective chart review was conducted to assess a 6-month clinical audit. Summary statistics were used to describe all variables. Results: Overall, 57 patients were included (mean age 26 years, 83% female). The median ingested dose (10 g) was similar between the regimens. An empiric indication occurred more in patients receiving the two-bag regimen (84.0% versus 50.0%). The median paracetamol level (231 umol/L) and the proportion of confirmed paracetamol toxicity (32%) were less in the two-bag regimen. A delay in initiating the first NAC infusion occurred in 22 (38.6%) patients. Forty adverse effects were recorded in 22 (38.6%) patients and a higher proportion occurred in the two-bag regime (44.0% vs. 34.4%). Nausea and vomiting occurred frequently (n=30, 52.7%), which were comparable for both regimens. The prevalence of hepatotoxicity after receiving NAC was 8.8% (n=5). Conclusion: A large number of patients were empirically started on NAC with a higher incidence of adverse reactions in the two-bag NAC than in the three-bag NAC regimen in contrast to existing evidence. However, there was a reduction in treatment delay in the two-bag NAC regimen compared to the three-bag NAC regimen. 2024-10-08T10:39:29Z 2024-10-08T10:39:29Z 2023 2024-05-16T13:39:48Z Thesis / Dissertation Masters MMed http://hdl.handle.net/11427/40563 Eng application/pdf Division of General Surgery Faculty of Health Sciences |
| spellingShingle | General Surgery Mbanga, Kedibone Clinical outcomes in patients with paracetamol ingestion treated with a two-bag n-acetylcysteine regimen in the emergency centre of khayelitsha hospital |
| thesis_degree_str | Master's |
| title | Clinical outcomes in patients with paracetamol ingestion treated with a two-bag n-acetylcysteine regimen in the emergency centre of khayelitsha hospital |
| title_full | Clinical outcomes in patients with paracetamol ingestion treated with a two-bag n-acetylcysteine regimen in the emergency centre of khayelitsha hospital |
| title_fullStr | Clinical outcomes in patients with paracetamol ingestion treated with a two-bag n-acetylcysteine regimen in the emergency centre of khayelitsha hospital |
| title_full_unstemmed | Clinical outcomes in patients with paracetamol ingestion treated with a two-bag n-acetylcysteine regimen in the emergency centre of khayelitsha hospital |
| title_short | Clinical outcomes in patients with paracetamol ingestion treated with a two-bag n-acetylcysteine regimen in the emergency centre of khayelitsha hospital |
| title_sort | clinical outcomes in patients with paracetamol ingestion treated with a two bag n acetylcysteine regimen in the emergency centre of khayelitsha hospital |
| topic | General Surgery |
| url | http://hdl.handle.net/11427/40563 |
| work_keys_str_mv | AT mbangakedibone clinicaloutcomesinpatientswithparacetamolingestiontreatedwithatwobagnacetylcysteineregimenintheemergencycentreofkhayelitshahospital |