{"id":{"repo_id":"cape-town","oai_identifier":"oai:open.uct.ac.za:11427/40563"},"canonical_url":"https://search.dev.ndltd.org/etd/cape-town/oai:open.uct.ac.za:11427/40563","repository":{"repo_id":"cape-town","name":"University of Cape Town","base_url":"https://open.uct.ac.za/oai/request"},"display":{"title":"Clinical outcomes in patients with paracetamol ingestion treated with a two-bag n-acetylcysteine regimen in the emergency centre of khayelitsha hospital","abstract":"Introduction: Paracetamol is frequently ingested for intentional self-poisoning. N-acetylcysteine (NAC) is administered to patients at risk of developing hepatotoxicity and was historically administered using a three-bag intravenous regimen. A change towards a two-bag NAC regimen was initiated at Khayelitsha Hospital. The aim of the study was to describe the clinical outcomes in patients with a history of paracetamol ingestion who were treated with the two-bag NAC regimen. A descriptive comparison to a historical cohort of patients treated with the three-bag NAC regimen was also made. Methods: A retrospective chart review was conducted to assess a 6-month clinical audit. Summary statistics were used to describe all variables. Results: Overall, 57 patients were included (mean age 26 years, 83% female). The median ingested dose (10 g) was similar between the regimens. An empiric indication occurred more in patients receiving the two-bag regimen (84.0% versus 50.0%). The median paracetamol level (231 umol/L) and the proportion of confirmed paracetamol toxicity (32%) were less in the two-bag regimen. A delay in initiating the first NAC infusion occurred in 22 (38.6%) patients. Forty adverse effects were recorded in 22 (38.6%) patients and a higher proportion occurred in the two-bag regime (44.0% vs. 34.4%). Nausea and vomiting occurred frequently (n=30, 52.7%), which were comparable for both regimens. The prevalence of hepatotoxicity after receiving NAC was 8.8% (n=5). Conclusion: A large number of patients were empirically started on NAC with a higher incidence of adverse reactions in the two-bag NAC than in the three-bag NAC regimen in contrast to existing evidence. However, there was a reduction in treatment delay in the two-bag NAC regimen compared to the three-bag NAC regimen.","abstract_html":"Introduction: Paracetamol is frequently ingested for intentional self-poisoning. N-acetylcysteine (NAC) is administered to patients at risk of developing hepatotoxicity and was historically administered using a three-bag intravenous regimen. A change towards a two-bag NAC regimen was initiated at Khayelitsha Hospital. The aim of the study was to describe the clinical outcomes in patients with a history of paracetamol ingestion who were treated with the two-bag NAC regimen. A descriptive comparison to a historical cohort of patients treated with the three-bag NAC regimen was also made. Methods: A retrospective chart review was conducted to assess a 6-month clinical audit. Summary statistics were used to describe all variables. Results: Overall, 57 patients were included (mean age 26 years, 83% female). The median ingested dose (10 g) was similar between the regimens. An empiric indication occurred more in patients receiving the two-bag regimen (84.0% versus 50.0%). The median paracetamol level (231 umol/L) and the proportion of confirmed paracetamol toxicity (32%) were less in the two-bag regimen. A delay in initiating the first NAC infusion occurred in 22 (38.6%) patients. Forty adverse effects were recorded in 22 (38.6%) patients and a higher proportion occurred in the two-bag regime (44.0% vs. 34.4%). Nausea and vomiting occurred frequently (n=30, 52.7%), which were comparable for both regimens. The prevalence of hepatotoxicity after receiving NAC was 8.8% (n=5). Conclusion: A large number of patients were empirically started on NAC with a higher incidence of adverse reactions in the two-bag NAC than in the three-bag NAC regimen in contrast to existing evidence. However, there was a reduction in treatment delay in the two-bag NAC regimen compared to the three-bag NAC regimen.","abstract_has_math":false,"creators":["Mbanga, Kedibone"],"institution":"Division of General Surgery","degree_name":null,"degree_level":null,"degree_discipline":null,"degree_department":null,"school":null,"contributors":[],"advisors":["Khan, Waseela"],"committee_chairs":[],"committee_members":[],"year":2023,"date_issued":"2023","date_published":"2023","updated_at":"2026-07-22T22:23:30Z","subjects":["General Surgery"],"languages":[],"rights":[],"rights_urls":[],"identifier_entries":[]},"links":{"outbound_url":"http://hdl.handle.net/11427/40563","outbound_label":"Handle","outbound_source":"dc:identifier.uri"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:contributor.advisor","label":"Advisor","values":["Khan, Waseela"]},{"key":"dc:creator","label":"Author","values":["Mbanga, Kedibone"]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"dc:date.accessioned","label":"Dc Date Accessioned","values":["2024-10-08T10:39:29Z"]},{"key":"dc:date.available","label":"Dc Date Available","values":["2024-10-08T10:39:29Z"]},{"key":"dc:date.issued","label":"Date","values":["2023"]},{"key":"dc:publisher.department","label":"Dc Publisher Department","values":["Division of General Surgery"]},{"key":"dc:type","label":"Dc Type","values":["Thesis / Dissertation"]},{"key":"dc:type.qualificationlevel","label":"Dc Type Qualificationlevel","values":["Masters","MMed"]}]},{"id":"subjects_keywords","label":"Subjects and Keywords","entries":[{"key":"dc:subject","label":"Dc Subject","values":["General Surgery"]}]},{"id":"identifiers","label":"Identifiers","entries":[{"key":"dc:identifier.uri","label":"Identifier URI","values":["http://hdl.handle.net/11427/40563"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description.abstract","label":"Abstract","values":["Introduction: Paracetamol is frequently ingested for intentional self-poisoning. N-acetylcysteine (NAC) is administered to patients at risk of developing hepatotoxicity and was historically administered using a three-bag intravenous regimen. A change towards a two-bag NAC regimen was initiated at Khayelitsha Hospital. The aim of the study was to describe the clinical outcomes in patients with a history of paracetamol ingestion who were treated with the two-bag NAC regimen. A descriptive comparison to a historical cohort of patients treated with the three-bag NAC regimen was also made. Methods: A retrospective chart review was conducted to assess a 6-month clinical audit. Summary statistics were used to describe all variables. Results: Overall, 57 patients were included (mean age 26 years, 83% female). The median ingested dose (10 g) was similar between the regimens. An empiric indication occurred more in patients receiving the two-bag regimen (84.0% versus 50.0%). The median paracetamol level (231 umol/L) and the proportion of confirmed paracetamol toxicity (32%) were less in the two-bag regimen. A delay in initiating the first NAC infusion occurred in 22 (38.6%) patients. Forty adverse effects were recorded in 22 (38.6%) patients and a higher proportion occurred in the two-bag regime (44.0% vs. 34.4%). Nausea and vomiting occurred frequently (n=30, 52.7%), which were comparable for both regimens. The prevalence of hepatotoxicity after receiving NAC was 8.8% (n=5). Conclusion: A large number of patients were empirically started on NAC with a higher incidence of adverse reactions in the two-bag NAC than in the three-bag NAC regimen in contrast to existing evidence. However, there was a reduction in treatment delay in the two-bag NAC regimen compared to the three-bag NAC regimen."]},{"key":"dc:title","label":"Title","values":["Clinical outcomes in patients with paracetamol ingestion treated with a two-bag n-acetylcysteine regimen in the emergency centre of khayelitsha hospital"]}]}],"canonical_facts":{"dc:contributor.advisor":["Khan, Waseela"],"dc:creator":["Mbanga, Kedibone"],"dc:date.accessioned":["2024-10-08T10:39:29Z"],"dc:date.available":["2024-10-08T10:39:29Z"],"dc:date.issued":["2023"],"dc:description.abstract":["Introduction: Paracetamol is frequently ingested for intentional self-poisoning. N-acetylcysteine (NAC) is administered to patients at risk of developing hepatotoxicity and was historically administered using a three-bag intravenous regimen. A change towards a two-bag NAC regimen was initiated at Khayelitsha Hospital. The aim of the study was to describe the clinical outcomes in patients with a history of paracetamol ingestion who were treated with the two-bag NAC regimen. A descriptive comparison to a historical cohort of patients treated with the three-bag NAC regimen was also made. Methods: A retrospective chart review was conducted to assess a 6-month clinical audit. Summary statistics were used to describe all variables. Results: Overall, 57 patients were included (mean age 26 years, 83% female). The median ingested dose (10 g) was similar between the regimens. An empiric indication occurred more in patients receiving the two-bag regimen (84.0% versus 50.0%). The median paracetamol level (231 umol/L) and the proportion of confirmed paracetamol toxicity (32%) were less in the two-bag regimen. A delay in initiating the first NAC infusion occurred in 22 (38.6%) patients. Forty adverse effects were recorded in 22 (38.6%) patients and a higher proportion occurred in the two-bag regime (44.0% vs. 34.4%). Nausea and vomiting occurred frequently (n=30, 52.7%), which were comparable for both regimens. The prevalence of hepatotoxicity after receiving NAC was 8.8% (n=5). Conclusion: A large number of patients were empirically started on NAC with a higher incidence of adverse reactions in the two-bag NAC than in the three-bag NAC regimen in contrast to existing evidence. However, there was a reduction in treatment delay in the two-bag NAC regimen compared to the three-bag NAC regimen."],"dc:identifier.uri":["http://hdl.handle.net/11427/40563"],"dc:publisher.department":["Division of General Surgery"],"dc:subject":["General Surgery"],"dc:title":["Clinical outcomes in patients with paracetamol ingestion treated with a two-bag n-acetylcysteine regimen in the emergency centre of khayelitsha hospital"],"dc:type":["Thesis / Dissertation"],"dc:type.qualificationlevel":["Masters","MMed"]},"updated_at":"2026-07-22T22:23:30Z"}