SGH Protocol for N-acetylcysteine (NAC) for paracetamol overdose and acute liver failure HUS1.

1/ver1/2020

Paracetamol Overdose
Patient’s Actual body
IC No:
name: weight (kg):

BW ≥ 40 kg without fluid restriction

Start date
IV NAC 200 mg/kg over 4 hours & time

STEP 200 mg × _______ (kg) BW = ______________ (mg) NAC

1
Dilute in 500 ml D5% and infuse over 4 hours.
Infusion rate:125 ml/hour (Signature)

Start date
IV NAC 50 mg/kg over 8 hours & time

STEP 50 mg × _______ (kg) BW = _______________ (mg) NAC

2
Dilute in 500 ml D5% and infuse over 8 hours.
(Signature)
Infusion rate: 63 ml/hour
Start date
IV NAC 50 mg/kg over 8 hours & time

STEP 50 mg × _______ (kg) BW = _______________ (mg) NAC

3
Dilute in 500 ml D5% and infuse over 8 hours.
Infusion rate: 63 ml/hour (Signature)

××××××××××××××××××××××××××××××××××××××××××××
BW < 40 kg and/or fluid restriction
Start date
IV NAC 200 mg/kg over 4 hours & time

STEP 200 mg × _______ (kg) BW = _____________ (mg) NAC

1
Dilute in 250 ml D5% and infuse over 4 hours.
(Signature)
Infusion rate:125 ml/hour
Start date
IV NAC 100 mg/kg over 16 hours & time

STEP 100 mg × _______ (kg) BW = ______________ (mg) NAC

2-3
Dilute in 500 ml D5% and infuse over 16 hours.
(Signature)
Infusion rate: 63 ml/hour
NOTE: Alternative diluent: Normal Saline (NaCl 0.9%)
Stability of diluted solution: 24 hours
Strength of NAC available: 200 mg/ml

Ordered by: Date:

(Signature & stamp)

Acute Liver Failure

Page 1
SGH Protocol for N-acetylcysteine (NAC) for paracetamol overdose and acute liver failure HUS1.1/ver1/2020
Patient’s Actual body
IC No:
name: weight (kg):

BW ≥ 40 kg without fluid restriction

IV NAC 150 mg/kg over 1 hour (150 mg/kg/hour) Start date & time

STEP
1 150 mg × _______ (kg) BW = ______________ (mg) NAC.
Dilute in 200 ml D5% and infuse over 1 hour. Infusion rate: 200 ml/hour (Signature)

IV NAC 50 mg/kg over 4 hours (12.5 mg/kg/hour) Start date & time

STEP
2 50 mg × _______ (kg) BW = ______________ (mg) NAC.
Dilute in 500 ml D5% and infuse over 4 hours. Infusion rate: 125 ml/hour (Signature)

IV NAC 150 mg/kg over 24 hours (6.25 mg/kg/hour) Start date & time

STEP
3 150 mg × _______ (kg) BW = ______________ (mg) NAC.
Dilute in 500 ml D5% and infuse over 24 hours. Infusion rate: 21 ml/hour (Signature)

IV NAC 150 mg/kg over 24 hours (6.25 mg/kg/hour) Start date & time

STEP
4 150 mg × _______ (kg) BW = ______________ (mg) NAC.
Dilute in 500 ml D5% and infuse over 24 hours. Infusion rate: 21 ml/hour (Signature)

IV NAC 118.75 mg/kg over 19 hours (6.25 mg/kg/hour) Start date & time

STEP
5 118.75 mg × _______ (kg) BW = ______________ (mg) NAC.
Dilute in 500 ml D5% and infuse over 19 hours. Infusion rate: 21 ml/hour (Signature)

××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××
BW < 40 kg and/or fluid restriction
IV NAC 150 mg/kg over 1 hour (150 mg/kg/hour) Start date & time

STEP
1 150 mg × _______ (kg) BW = ______________ (mg) NAC.
Dilute in 100 ml D5% and infuse over 1 hour. Infusion rate: 100 ml/hour (Signature)

IV NAC 50 mg/kg over 4 hours (12.5 mg/kg/hour) Start date & time

STEP
2 50 mg × _______ (kg) BW = ______________ (mg) NAC.
Dilute in 250 ml D5% and infuse over 4 hours. Infusion rate: 63 ml/hour (Signature)

IV NAC 150 mg/kg over 24 hours (6.25 mg/kg/hour) Start date & time

STEP
3 150 mg × _______ (kg) BW = ______________ (mg) NAC.
Dilute in 250 ml D5% and infuse over 24 hours. Infusion rate: 11 ml/hour (Signature)

IV NAC 150 mg/kg over 24 hours (6.25 mg/kg/hour) Start date & time

STEP
4 150 mg × _______ (kg) BW = ______________ (mg) NAC.
Dilute in 250 ml D5% and infuse over 24 hours. Infusion rate: 11 ml/hour (Signature)

IV NAC 118.75 mg/kg over 19 hours (6.25 mg/kg/hour) Start date & time

STEP
5 118.75 mg × _______ (kg) BW = ______________ (mg) NAC.
Dilute in 250 ml D5% and infuse over 19 hours. Infusion rate: 11 ml/hour (Signature)

Ordered by: Date:

(Signature & stamp)

Page 2