The studies undertaken by Prescott et al and Vale et al in the 1970's seem to involve similar groups of patients, and there were no significant differences between oral and IV methionine (7% and 2% hepatotoxicity respectively). It was not included in Buckley's meta-analysis because the patients were not recruited sequentially and it was unclear whether the patients were treated solely at the study centre (possible variations in other treatment modalities could act as confounding factors).Ī number of other papers compared methionine, either IV or oral, with symptomatic treatment only, although with two exceptions it is difficult to directly compare the results. Perry's study used historical controls although the demographic characteristcs of the two groups were remarkably similar. The duration of the IV regimes varied with 3 studies using 20 hours and one using 48 hours Meta-analysis - there was no significant difference in the hepatotoxicity rates between IV and oral NAC, irrespective of time from ingestion to treatment. Observational - Hepatotoxicity was associated with larger ingestions and delayed presentations. Hepatotoxicity 8% IV 6.9% oral 0% either group when treated 1000 u/l) No significant difference was discovered between IV and oral NAC. Relevant Paper(s) Author, date and country AND AND LIMIT to human AND English languageģ30 papers were identified, of which two were directly relevant to the three part question. Medline 1966-12/01 using the OVID interface. You wonder whether oral antidote is as effective. She does not want to be treated with intravenous therapy. Her four hour paracetamol levels are above the treatment line. In is at ? Clinical ScenarioĪ 23 year old woman attends an emergency department having taken sixty 500mg paracetamol tablets.

Paracetamol antidote