Abstract
ISMP Canada received three reports of death or severe harm involving intravenous acetylcysteine (also known as N-acetylcysteine) overdose related to one type of error—continuation of the loading dose IV infusion rate instead of reduction to a lower rate for the maintenance dose. All resulted in a 10-fold dosing error. An alert was published in 2022, and a follow-up safety bulletin in 2023 shared findings from a multi-incident analysis with recommendations (ISMP Canada, 2022 & 2023). There are many protocols/regimens in use across Canada for the preparation and administration of acetylcysteine, each with potential benefits and risks. This column shares key findings and several strategies to support the safe administration of acetylcysteine. Critical care nurses’ specialized expertise in patient monitoring and fluid management is vital for optimal care outcomes.
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