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Improved outcome of paracetamol-induced fulminant hepatic failure by late administration of NAC[Lancet 1990 Jun 30;335(8705):1572-3] The influence of NAC, administered at presentation to hospital, on the subsequent clinical course of 100 patients who developed APAP-induced fulminant hepatic failure was analyzed retrospectively Mortality was 37% in patients who received NAC 10-36 h after the overdose, compared with 58% in patients not given the antidote In patients given NAC, progression to grade III/IV coma was significantly less common than in those who did not receive the antidote (51% vs 75%) TREATMENT NAC is indicated in All patients with a serum APAP concentration above the possible hepatic toxicity line on the Rumack-Matthew nomogram Patients with an estimated ingestion of greater than 140 mg/kg Patients with an unknown time of ingestion Patients with a presentation more than 24 hours after ingestion with elevated transaminases TREATMENT NAC regimen is used in the United States A loading dose of 140 mg/kg in a five percent solution is given either orally or via nasogastric tube This is followed by 70 mg/kg every four hours for 17 doses