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


  • Ed Oakley, MBBS, FACEM, Director Paediatric Emergency Medicine, Honorary Research Fellow; Jeff Robinson, B. Pharm., F.S.H.P., Grad. Dip. Hosp. Pharm, Manager; Conor Deasy, FCEM, Dip Tox, PhD student and Emergency Medicine International Fellow.

  • Using saline containing solutions for infusing N-acetylcysteine – a case series

  • Financial disclosure: No financial benefits were gained or stand to be gained by any of the authors by the publication of the present article. The authors have no links to pharmaceutical manufactures.

Dr. Edward Oakley, Department of Emergency Medicine, Monash Medical Centre, 246 Clayton Road Clayton Vic. 3168, Australia. Email:


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 9 years 6 months (95% CI 4 years 4 months to 15 years 1 month) and the range 3 months to 17 years. All patients had NAC infused in a two-stage infusion regimen (150 mg/kg bolus over 1 h followed by a continuous infusion of 10 mg/kg/h for 20 h). The serum sodium was measured in all 40 patients with a mean of 140 (range of 133 to 152 mmol/L). Repeat sodium was measured in 35 cases, with a mean of 140 mmol/L (range from 134 to 149 mmol/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.