Improvement by Acetylcysteine of Hemodynamics and Oxygen Transport in Fulminant Hepatic Failure
Open accessAbstract
BACKGROUND: When administered early after an overdose of acetaminophen, intravenous acetylcysteine prevents hepatic necrosis by replenishing reduced stores of glutathione. How acetylcysteine improves the survival of patients with established liver damage induced by acetaminophen, however, is unknown. This study was undertaken to determine whether the beneficial effect of acetylcysteine under such circumstances could be due to enhancement of oxygen delivery and consumption. METHODS: We studied the effect of acetylcysteine on systemic hemodynamics and oxygen transport in 12 patients with acetaminophen-induced fulminant hepatic failure and 8 patients with acute liver failure from other causes. The acetylcysteine was given in a dose of 150 mg per kilogram of body weight in 250 ml of 5 percent dextrose over a period of 15 minutes and then in a dose of 50 mg per kilogram in 500 ml of 5 percent dextrose over a period of 4 hours; measurements were made before treatment began and after 30 minutes of the regimen. RESULTS: In the patients with acetaminophen-induced liver failure, the infusion of acetylcysteine resulted in an increase in mean oxygen delivery from 856 to 975 ml per minute per square meter of body-surface area (P = 0.0036), due to an increase in the cardiac index from 5.6 to 6.7 liters per minute per square meter (P = 0.0021). Mean arterial pressure rose from 88 to 95 mm Hg (P = 0.0054) despite a decrease in systemic vascular resistance from 1296 to 1113 dyn.sec.cm-5 per square meter (P = 0.027). There was an increase in oxygen consumption from 127 to 184 ml per minute per square meter (P = 0.0007) associated with an increase in the oxygen-extraction ratio from 16 to 21 percent (P = 0.022). The effects in the patients with acute liver failure from other causes were similar. CONCLUSIONS: The increase in oxygen delivery and consumption in response to acetylcysteine may account for its beneficial effect on survival in patients with fulminant hepatic failure induced by acetaminophen.
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Several observations suggest NAC has other mechanisms effective even after NAPQI formation and binding, including enhancement of oxygen delivery and utilization.
“However, several observations suggest that NAC has other mechanisms of action that are effective also after NAPQI formation and binding: enhancement of oxygen delivery and utilization (70,96,204).”
From Paracetamol: New Vistas of an Old Drug (2006) · cites this paper as [96]
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Self-citation
- Authors
- Harrison, P. M., Wendon, J. A., Gimson, A. E. S., Alexander, G. J. M., & Williams, R.
- Affiliations
- King's College London (GB)
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 1991-06-27
- Volume
- 324
- Issue
- 26
- Pages
- 1852-1857
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2313265919
- Cited by
- 585
- References
- 42
- Citations by year
- 2026: 2 · 2025: 6 · 2024: 10 · 2023: 9 · 2022: 7 · 2021: 13 · 2020: 14 · 2019: 14 · 2018: 18 · 2017: 17 · 2016: 15 · 2015: 18 · 2014: 12 · 2013: 20 · 2012: 22
- FWCI
- 17.42
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Drug-Induced Hepatotoxicity and Protection
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Health Sciences › Medicine › Emergency Medicine › Poisoning and overdose treatments
- Keywords
- N-acetylcysteine, acute liver failure, acetaminophen overdose, oxygen delivery, oxygen consumption, hemodynamics, cardiac index, systemic vascular resistance, oxygen extraction fraction, glutathione
- MeSH terms
- Acetaminophen, Acetylcysteine, Adolescent, Adult, Biological Transport, Female, Hemodynamics, Hepatic Encephalopathy, Hepatitis, Alcoholic, Hepatitis C, Humans, Male, Middle Aged, Oxygen, Oxygen Consumption, Chemical and Drug Induced Liver Injury, Drug Overdose
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