Abstract
From its first use in paracetamol (Acetaminophen, APAP) overdose, oral acetylcysteine (NAC) was controversial [1,2]. Intravenous (IV) NAC was initially no less provocative [3,4]. Yet, over a few short years both the 72-h oral, and the 20-h IV protocols rapidly became standard practices. Three facts likely hampered altering these regimens: (1) The case-fatality rate in untreated patients was very low. (2) The case-fatality rate in NAC-treated patients was even lower, suggesting efficacy. (3) Although some patients developed hepatotoxicity despite NAC, recovery was generally complete and uneventful.
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