Using 0.45% saline solution and a modified dosing regimen for infusing N-acetylcysteine in children with paracetamol poisoning

Introduction: N-acetylcysteine (NAC) administration is recommended to all patients judged to be at risk of developing hepatotoxicity following paracetamol overdose. However, it has been shown that standard i.v. dosing can cause symptomatic hyponatraemia in children. We describe a case series using 0.45% NaCl plus 5% dextrose for infusing i.v. NAC in children with paracetamol poisoning. Case series: A retrospective review of medical records of patients treated with NAC using 0.45% saline plus 5% dextrose, and a novel two-stage dosing regimen between January 2003 and July 2006 were undertaken. Results: A total of 40 patients (20 male and 20 female) who received NAC in 0.45% sodium chloride (NaCl) with 5% dextrose were identified. Mean age was 9years 6months (95% CI 4years 4months to 15years 1month) and the range 3months to 17years. All patients had NAC infused in a two-stage infusion regimen (150mg/kg bolus over 1h followed by a continuous infusion of 10mg/kg/h for 20h). The serum sodium was measured in all 40 patients with a mean of 140 (range of 133 to 152mmol/L). Repeat sodium was measured in 35 cases, with a mean of 140mmol/L (range from 134 to 149mmol/L). Conclusion: These findings support the use of saline-containing solutions to administer NAC as an alternative to 5% dextrose, and suggest that a two-stage infusion regimen should be further investigated with prospective studies.