Emerging treatments
Abbreviated acetylcysteine infusion protocol for therapeutic excess of paracetamol
A retrospective chart review suggests that an 8-hour acetylcysteine infusion regimen may be safe for patients who present with therapeutic excess of paracetamol and are at low risk of hepatotoxicity (serum paracetamol concentration <10 mg/L, alanine aminotransferase normal or static after 8 hours of infusion).[66] Further research is required.
Risk stratification using mechanistic biomarkers
In two prospective cohort studies, a combined model of microRNA-122 (miR-122), keratin-18 (K18), and high mobility group box-1 (HMGB1) predicted acute liver injury better than alanine aminotransferase alone in patients who required acetylcysteine treatment for paracetamol overdose (early-presenting acute overdose or late-presenting acute and staggered overdose).[39]
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