Jove
Visualize
Contact Us
JoVE
x logofacebook logolinkedin logoyoutube logo
ABOUT JoVE
OverviewLeadershipBlogJoVE Help Center
AUTHORS
Publishing ProcessEditorial BoardScope & PoliciesPeer ReviewFAQSubmit
LIBRARIANS
TestimonialsSubscriptionsAccessResourcesLibrary Advisory BoardFAQ
RESEARCH
JoVE JournalMethods CollectionsJoVE Encyclopedia of ExperimentsArchive
EDUCATION
JoVE CoreJoVE BusinessJoVE Science EducationJoVE Lab ManualFaculty Resource CenterFaculty Site
Terms & Conditions of Use
Privacy Policy
Policies

Related Concept Videos

Prevention of Further Absorption of Poison01:14

Prevention of Further Absorption of Poison

954
In cases of acute poisoning, the primary objective is to prevent further absorption of the toxic substance into the body. Immediate interventions using various decontamination techniques targeting the gastrointestinal (GI) tract can achieve this. Decontamination is crucial to prevent poison from entering the systemic circulation, which involves washing affected areas with water and mild soap and removing contaminated clothing. Once external decontamination is done, attention must be turned to...
954
Anticholinesterase Agents: Poisoning and Treatment01:26

Anticholinesterase Agents: Poisoning and Treatment

1.1K
Anticholinesterases, also known as cholinesterase inhibitors, work by blocking the breakdown of acetylcholine, leading to its accumulation in the synaptic cleft. This accumulation indirectly enhances both muscarinic and nicotinic actions. These agents are classified as reversible or irreversible based on their mechanism of action.     
Irreversible agents form a strong bond with the cholinesterase enzyme, making it inactive. The breakdown of the phosphorylated enzyme is...
1.1K
Nonlinear Pharmacokinetics: Dependence of Elimination Half-Life and Dose Clearance01:23

Nonlinear Pharmacokinetics: Dependence of Elimination Half-Life and Dose Clearance

336
The elimination half-life and drug clearance of drugs following nonlinear kinetics can vary with dosage. The Michaelis-Menten parameters and drug concentration influence these factors. As the dose increases, the elimination half-life tends to lengthen, resulting in a reduction in clearance and a disproportionately larger area under the curve. The total clearance can be derived from the Michaelis-Menten equation for drugs following a one-compartment model.
A study on guinea pigs examined the...
336
Acute Pancreatitis II: Clinical Manifestations and Management01:30

Acute Pancreatitis II: Clinical Manifestations and Management

315
Acute pancreatitis presents a complex medical emergency characterized by rapid onset inflammation of the pancreas, demanding timely diagnosis and management to prevent complications. The condition primarily manifests through severe upper abdominal pain that often radiates to the back. This pain intensifies following the consumption of fatty foods. Accompanying symptoms such as nausea, vomiting, abdominal distention, fever, dyspnea, cyanosis, and jaundice can vary in intensity but significantly...
315
Enhanced Elimination of Poison01:26

Enhanced Elimination of Poison

606
Poison can be effectively removed from the gastrointestinal (GI) tract through various decontamination procedures.
Antidotes serve a crucial role in counteracting the effects of poison by inhibiting enzymes responsible for producing harmful drug metabolites. In some cases, these toxic metabolites can be neutralized by endogenous cosubstrates, which are maintained at specific concentrations to prevent interaction with cellular macromolecules and subsequent cell death.
Renal excretion is the...
606
Drug Delivery: Enteral Route01:18

Drug Delivery: Enteral Route

832
The enteral drug administration involves three primary routes: oral, sublingual, and buccal. Oral ingestion is the most prevalent, safe, economical, and convenient method for drug administration. However, it has certain drawbacks, including limited absorption due to the drug's low water solubility or poor membrane permeability, possible emesis from GI mucosa irritation, destruction of drugs by digestive enzymes or low gastric pH, and irregular absorption along with food or other drugs.
832

You might also read

Related Articles

Articles linked to this work by shared authors, journal, and citation graph.

Sort by
Same author

Management of patients with suspected but unidentified poisoning in the emergency department: a joint Royal College of Emergency Medicine and National Poisons Information Service best practice guideline.

Emergency medicine journal : EMJ·2026
Same author

Paediatric colchicine poisoning in the UK: a 10-year retrospective case series from the National Poisons Information Service.

Archives of disease in childhood·2026
Same author

A 10-year retrospective review of mushroom exposures reported to the United Kingdom National Poisons Information Service between 2013 and 2022.

Clinical toxicology (Philadelphia, Pa.)·2025
Same author

Paracetamol (acetaminophen) poisoning; consensus definitions of poisoning types and outcomes to be used in the clinical toxicology recommendations collaborative systematic review.

Clinical toxicology (Philadelphia, Pa.)·2025
Same author

Poisoning in adolescents in the UK: a review of enquiries to the National Poisons Information Service.

Archives of disease in childhood·2025
Same author

Trends in tricyclic antidepressant prescribing and poisoning in England and Wales 2016-2020.

British journal of clinical pharmacology·2025

Related Experiment Video

Updated: Oct 8, 2025

Generation of a Rat Model of Acute Liver Failure by Combining 70% Partial Hepatectomy and Acetaminophen
09:44

Generation of a Rat Model of Acute Liver Failure by Combining 70% Partial Hepatectomy and Acetaminophen

Published on: November 27, 2019

10.4K

Large paracetamol overdose - Higher dose NAC is NOT required.

H K Ruben Thanacoody1,2

  • 1Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne, UK.

British Journal of Clinical Pharmacology
|December 24, 2021
PubMed
Summary

High dose acetylcysteine (NAC) is effective for most paracetamol overdoses. Modified NAC regimens may reduce liver damage in massive overdoses, but further research is needed to confirm benefits for severe outcomes.

Keywords:
acetylcysteineoverdoseparacetamol

More Related Videos

Intracerebroventricular Treatment with Resiniferatoxin and Pain Tests in Mice
06:04

Intracerebroventricular Treatment with Resiniferatoxin and Pain Tests in Mice

Published on: September 2, 2020

8.4K
Preparation of Naringenin Solution for In Vivo Application
08:18

Preparation of Naringenin Solution for In Vivo Application

Published on: August 10, 2021

3.5K

Related Experiment Videos

Last Updated: Oct 8, 2025

Generation of a Rat Model of Acute Liver Failure by Combining 70% Partial Hepatectomy and Acetaminophen
09:44

Generation of a Rat Model of Acute Liver Failure by Combining 70% Partial Hepatectomy and Acetaminophen

Published on: November 27, 2019

10.4K
Intracerebroventricular Treatment with Resiniferatoxin and Pain Tests in Mice
06:04

Intracerebroventricular Treatment with Resiniferatoxin and Pain Tests in Mice

Published on: September 2, 2020

8.4K
Preparation of Naringenin Solution for In Vivo Application
08:18

Preparation of Naringenin Solution for In Vivo Application

Published on: August 10, 2021

3.5K

Area of Science:

  • Toxicology
  • Pharmacology
  • Hepatology

Background:

  • Paracetamol (acetaminophen) overdose is a frequent clinical issue, with large ingestions (>30g or 500mg/kg) being less common.
  • Hepatotoxicity can occur even with early standard-dose N-acetylcysteine (NAC) treatment, prompting investigation into alternative regimens for massive overdoses.

Purpose of the Study:

  • To evaluate the effectiveness of the standard intravenous NAC regimen in patients with large paracetamol overdoses.
  • To explore the potential benefits of a modified, higher-dose NAC regimen (400-500mg/kg) in reducing hepatotoxicity in severe paracetamol overdose cases.
  • To discuss the need for improved risk stratification to guide targeted interventions for high-risk patients.

Main Methods:

  • Review of evidence from patient cohorts treated with standard NAC regimens for large paracetamol overdoses.
  • Analysis of a small study investigating a modified NAC regimen in patients with extreme paracetamol ingestions and high serum concentrations.
  • Discussion of adjunctive therapies like CYP2E1 inhibition and extracorporeal paracetamol removal.

Main Results:

  • The standard 300mg/kg intravenous NAC regimen is effective for the majority of large paracetamol overdoses.
  • A modified NAC regimen (400-500mg/kg over 21-22h) showed potential in reducing hepatotoxicity (ALT > 1000 IU/L) in a small study of severe overdoses.
  • The impact of modified NAC regimens on hepatic failure, liver transplantation, and mortality remains unknown.

Conclusions:

  • Standard NAC treatment is largely effective for paracetamol overdose.
  • Higher-dose NAC regimens may offer additional protection against hepatotoxicity in massive overdoses, but require further investigation regarding clinical outcomes.
  • Enhanced risk stratification is crucial for identifying patients who would benefit most from intensified NAC protocols and adjunctive therapies.