• August Supervía, M ª Àngels Gispert, Jordi Puiguriguer, Pablo Borja Álvarez Zabala, Lidia Martínez Sánchez, Samuel Olmos, Beatriz Calderón, Rocío de Paz Picornell, Santiago Nogué, and Francisca Córdoba.
• Servicio de Urgencias, Hospital Universitario del Mar, Barcelona, España. Unitat Funcional de Toxicología, Hospital Universitario del Mar, Barcelona, España. Grup de treball de Toxicologia de la SoCMUE (SoCMUETox).
• Emergencias. 2025 Feb 1; 37 (1): 394339-43.

ObjectiveParacetamol poisoning can be serious and require treatment with N-acetylcysteine (NAC). A dose of 300 mg/kg is usually given in 3 fractions over 21 hours. An alternative regimen, the Scottish and Newcastle Acetylcysteine Protocol (SNAP), specifies the same total dose given in 2 intravenous injections over 12 hours. This study aimed to compare the 2 regimens in terms of effectiveness, adverse events, and lengths of emergency department (ED) and hospital stays.MethodsProspective multicenter study to compare outcomes associated with the traditional NAC regimen vs SNAP. We enrolled all patients with paracetamol poisoning requiring NAC treatment in the participating hospital EDs from 2021 through 2023. Data related to referrals, poisoning episodes, and discharge destinations were collected. Patients were studied in 2 groups according to the protocol assigned in the EDs.ResultsA total of 165 patients were treated (SNAP, 103; traditional protocol, 62). The mean (SD) age was 28.1 (19.7) years, and most were female (70.5%). No differences in peak transaminase levels were observed. SNAP-treated patients had significantly fewer adverse effects as well as shorter stays both in the ED (17.8 [15.2] hours vs 25.9 [17.1] hours; P = .001) and on the ward (2.6 [2.3] days vs 4.4 [3.6] days; P = .019).ConclusionsFewer adverse events occurred with the SNAP approach. The 2 protocols were similarly effective. The SNAP-treated patients spent less time in the ED, and those who were admitted to hospital had shorter stays.

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