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Weight-based N-acetylcysteine dosing chart to minimise the risk of calculation errors in prescribing and preparing N-acetylcysteine infusions for adults presenting with paracetamol overdose in the emergency department
  1. V A Selvan1,
  2. S H S Calvert2,
  3. G Cavell1,
  4. E Glucksman2,
  5. M Kerins2,
  6. J Gonzalez3
  1. 1Pharmacy Department, Kings College Hospital, NHS Foundation Trust, London, UK
  2. 2Emergency Department, Kings College Hospital, NHS Foundation Trust, London, UK
  3. 3Biostatistics Department, Kings College Hospital, NHS Foundation Trust, London, UK
  1. Correspondence to:
 Vijay A Selvan
 Pharmacy Department, King’s College Hospital NHS Foundation Trust, London, SE5 9RS, UK; vijay.selvan{at}


Management of paracetamol overdose (POD) is common in the emergency department (ED) and forms part of the clinical effectiveness audit programme of the British Association for Emergency Medicine. N-acetylcysteine (NAC) infusion regimens for the treatment of POD are complicated and prescribing and administration errors have been well documented. This study assessed the ability of doctors and nurses to calculate correct doses using manual calculation skills and a weight-based NAC dosing chart when prescribing and preparing NAC infusions. With manual calculations, errors were made by doctors and nurses in 26% of cases collectively. No errors were made using the dosing chart. The dosing chart ensured 100% accuracy in dose calculations, which may translate into improved patient safety.

  • CV, coefficient of variation
  • ED, emergency department
  • ICC, intra-class correlation coefficient
  • NAC, N-acetylcysteine
  • POD, paracetamol overdose

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  • Competing interests: None declared.