Acetaminophen remains one of the most common potentially lethal ingested substances encountered in clinical practice.1 Treatment for acetaminophen poisoning in the United States has remained the same during the past few years, while treatment outside the United States has taken a different path. The clinical standard between the United States and other countries differs in regard to intravenous acetylcysteine. The oral acetylcysteine protocol used in the United States has been effective. However, there are certain conditions, such as severe vomiting, for which oral administration is not possible. Great Britain and Canada use an intravenous formulation of acetylcysteine that has been available for many years.2 Intravenous acetylcysteine is not approved by the Food and Drug Administration (FDA), but certain instances have arisen during which the use of oral acetylcysteine intravenously has been potentially lifesaving.
Amirzadeh A, McCotter C. The Intravenous Use of Oral Acetylcysteine (Mucomyst) for the Treatment of Acetaminophen Overdose. Arch Intern Med. 2002;162(1):96-97. doi: