Acetylcysteine for hepatoprotection
Acetylcysteine is easily accessible and widely used for hepatoprotection from many toxic agents, including Amanita phalloides mushrooms, and has a relatively low risk of harm.
It is recommended that patients with Amanita phalloides poisoning receive acetylcysteine treatment in addition to other antidotes. An initial two-bag (20-hour) intravenous acetylcysteine infusion is recommended.
For adults, use:
acetylcysteine 200 mg/kg (up to 22 g) in crystalloid solution 500 mL intravenously, over 4 hours1 amanita phalloides mushroom poisoning
FOLLOWED BY
acetylcysteine 100 mg/kg (up to 11 g) in crystalloid solution 1000 mL intravenously, over 16 hours1.
For children, use:
acetylcysteine 200 mg/kg in crystalloid solution 7 mL/kg (up to 500 mL) intravenously, over 4 hours1
FOLLOWED BY
acetylcysteine 100 mg/kg in crystalloid solution 14 mL/kg (up to 1000 mL) intravenously, over 16 hours1.
Two hours before completing the second infusion, repeat the serum alanine aminotransferase (ALT) concentration and international normalised ratio (INR). Extended acetylcysteine treatment is indicated if the serum ALT concentration is raised or the INR is more than 1.5.
For adults, use:
acetylcysteine 100 mg/kg (up to 11 g) in crystalloid solution 1000 mL intravenously, over 16 hours1.
For children, use:
acetylcysteine 100 mg/kg in crystalloid solution 14 mL/kg (up to 1000 mL) intravenously, over 16 hours1.
Repeat the 16-hour acetylcysteine infusion until the serum ALT concentration is falling, the INR is less than 1.5, and the patient has only mild symptoms or is asymptomatic.
For information on immediate immune-mediated (non-IgE) hypersensitivity reactions to acetylcysteine therapy, see Immediate immune-mediated (non-IgE) hypersensitivity reactions to acetylcysteine.