Baseline laboratory data to be obtained include CBC, platelets, BUN, creatinine, electrolytes, glucose, urinalysis. When begun later efficacy decreases as time post-ingestion increases. Orange juice, color, or grapefruit juice can increase palatability. If the patient vomits within one hour of a dose, that dose should be repeated. Allergic reactions to oral NAC are very uncommon.
Asthmatic patients are especially at risk.
With the high rate of anaphylactoid reactions to IV NAC, oral NAC will continue to have an important role in the treatment of APAP intoxication. IV NAC will be a great advantage for the treatment of cases with intractable vomiting not controlled with antiemetics. As in all areas of toxicology, the pregnant patient presents a difficult dilemma. The outcome of the pregnancy will be affected by the time post-ingestion that treatment with NAC is started. The data available suggest that pregnant patients who demonstrate a potentially hepatotoxic APAP level should be treated with NAC as soon as possible.