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Intravenous N-acetylcysteine is associated with fewer of the adverse effects seen with the oral preparation, such as nausea, vomiting, abdominal pain, diarrhea and rash, but it carries a higher risk of anaphylactoid reactions.9 When patients present relatively late after ingestion, oral N-acetylcysteine protocols provide a higher dose given over a longer period, which may be an advantage.2 , 10 However, the gastrointestinal adverse effects associated with oral therapy are a substantial disadvantage, notably if this results in a longer time for drug absorption and hence a longer time to reach therapeutic effect.2 Since the introduction and adoption of routine use of N-acetylcysteine therapy, the mortality rate in acetaminophen overdose has declined from 3% to 0.7%.11 Prevention of overdose and medication errors in children This report highlights the issue of accurate dosing in pediatrics

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Konopleva M, Ruvolo P, Contractor R, Kurinna S, Xie Z, Milella M, Andreeff M

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