Methodology: 3.5/5
Usefulness: 4/5
Isbister G, et al. J Hepatol. 2025 Oct;83(4):881-887. doi: 10.1016/j.jhep.2025.05.008.
Question and Methods: This multicentre unblinded RCT with 204 patients assessed non-inferiority of a 12-hour NAC protocol for single non-massive acetaminophen ingestion compared to a standard 20-hour protocol.
Findings: The 12-hour protocol was non-inferior to the 20-hour protocol median delta ALT at 24 hours was -2 U/L; IQR -7 to 1 U/L vs. -1 U/L; IQR -5 to 1.5 U/L. There were no statistically significant differences in hypersensitivity reactions or GI side effects.
Limitations: Limitations include a lack of patient blinding and a lack of data on patient pre-existing medical conditions or co-ingestions.
Interpretation: This paper supports the Ontario Poison Control guideline for individualized acetaminophen toxicity care. Patients with single non-massive ingestions should be considered for a shortened 12-hour NAC protocol in consultation with local poison control.
JC Supervisor: Dr. Venkatesh Thiruganasambandamoorthy
