The NACSTOP trial: Investigation of the early cessation of N-acetylcysteine after paracetamol overdose.

All patients with normal ALT and AST (within lab reference range) and paracetamol<132 micro mol/L, will be allocated to either intervention or control treatment. 200mg/kg of NAC intravenously over 4 hours, then 50mg/kg NAC over 8 hours intravenously then change to 1 litre of intravenous Compound serum Lactate over 8 hours if study criteria met at 12 hours (alanine transaminase and AST less than the upper limit of the lab reference range, paracetamol <132 micro mol/L) in intervention group. Bloods will then be repeated again at 20 hrs post initiation of NAC. A normal alanine transaminase indicates no sign of liver toxicity and low paracetamol concentration at less than therapeutic dose of paracetamol in the blood. Lab reference range for ALT, AST will vary from institution but the higher end of the range is 50 IU/L. Strategies to monitor medication adherence include observation in hospital of administration by medical and nursing staff, and computer logging of drug administration by nursing staff.