Implementation

• After opening, solution for inhalation may turn light purple; does not alter potency. Refrigerate open vials and discard after 96 hr

» Drug reacts with rubber and metals (iron, nickel, copper); avoid contact with these substances

• PO: Acetaminophen Overdose— First empty stomach contents by inducing emesis or lavage. Dilute 20% solution with cola, water, or juice to a final concentration of 1:3 for patients weighing up to 20 kg or with enough diluent to make a 5% solution for patients weighing more than 20 kg, to increase palatability. May be administered by duodenal tube if patient is unable to swallow. If patient vomits loading dose or maintenance doses within 1 hr of administration, readminister dose

• Intermittent Infusion:
Most effective if administered within 8 hrs of acetaminophen ingestion. Dilute in D5W. For loading dose: Dilute 150 mg/kg in 200 mL. For 1st Maintenance Dose: Dilute 50 mg/kg in 500 mL. For 2nd Maintenance Dose: Dilute 100 mg/kg in 1000 ML. Adjust fluid volume for patients <40 kg or requiring fluid restriction. Vials are single-use. Discard after using. Reconstituted solution is stable for 24 hr at room temperature

• Rate:
Administer Loading Dose over 15 min
Administer 1st Maintenance Dose over 4 hr
Administer 2nd Maintenance Dose over 16 hr

• Inhaln:
Mucolytic— Encourage adequate fluid intake (2000–3000 ml/day) to decrease viscosity of secretions
For nebulization, the 20% solution may be diluted with 0.9% NaCl for injection or inhalation or sterile water for injection or inhalation. May use 10% solution undiluted. May be administered by nebulization, or 1–2 ml may be instilled directly into airway. During administration, when 25% of medication remains in nebulizer, dilute with equal amount of 0.9% NaCl or sterile water
An increased volume of liquefied bronchial secretions may occur following administration. Have suction equipment available for patients unable to effectively clear airways
If bronchospasm occurs during treatment, discontinue and consult health care professional regarding possible addition of bronchodilator to therapy. Patients with asthma or hyperactive airway disease should be given a bronchodilator prior to acetylcysteine to prevent bronchospasm
Rinse patient's mouth and wash face following treatment, as drug leaves a sticky residue

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