Emerg Med J 19:594-595 doi:10.1136/emj.19.6.594
  • Case report

Fatal anaphylactoid reaction to N-acetylcysteine: caution in patients with asthma

  1. A V Appelboam1,
  2. P I Dargan2,
  3. J Knighton1
  1. 1Queen Alexandra Hospital, Portsmouth, UK
  2. 2National Poisons Information Service, London, UK
  1. Correspondence to:
 Dr A Appelboam, Department of Anaesthetics, Torbay Hospital, Torquay, Devon TQ2 7AA;
  • Accepted 31 January 2002


Paracetamol overdose is a common reason for presentation to the emergency department and N-acetylcysteine is frequently used in the treatment of toxic paracetamol ingestions. Adverse reactions to N-acetylcysteine are common though usually mild and easily treated. Serious reactions to N-acetylcysteine however, are rare and there have been no previous reported fatalities with its therapeutic use. This report describes the case of a 40 year old brittle asthmatic patient who died after treatment with intravenous N-acetylcysteine. Asthma is a risk factor for adverse reactions to N-acetylcysteine and special caution should be exercised in its use in brittle asthmatic patients.