Letters Treatments for paracetamol poisoning

Authors’ reply to Thomas and colleagues

BMJ 2016; 353 doi: https://doi.org/10.1136/bmj.i3461 (Published 28 June 2016) Cite this as: BMJ 2016;353:i3461
  1. Nicholas A Buckley, professor of clinical pharmacology and toxicology1 2 3,
  2. Andrew H Dawson, clinical toxicology specialist1 2 3,
  3. Geoffrey K Isbister, clinical toxicologist and emergency physician1 4
  1. 1NSW Poisons Information Centre, Sydney, NSW, Australia
  2. 2Sydney Medical School, University of Sydney, Sydney NSW 2006, Australia
  3. 3Department of Clinical Toxicology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
  4. 4Clinical Toxicology Research Group, University of Newcastle, Newcastle, NSW, Australia
  1. nicholas.buckley{at}sydney.edu.au

We agree with Thomas and colleagues that evidence to date has shown the updated guidance on acetylcysteine to be an expensive strategy with no demonstrable net benefit: frequent adverse effects of acetylcysteine possibly outweigh the postulated small reduction in severe hepatotoxicity.1 2

Moreover, the change has generated conflicting advice on threshold doses for initiating treatment. Current …

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