A 38-year-old woman is being treated for a paracetamol overdose with acetylcysteine. Shortly after treatment started, she developed nausea, an urticarial rash and mild wheeziness.
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She has developed an anaphylactoid reaction to acetylcysteine. Acetylcysteine can cause anaphylactoid reactions with vomiting, flushing, urticaria, angioedema, bronchospasm and rarely shock. Very rarely, it can also cause respiratory depression, acute kidney injury and DIC.
Reactions occur in around 20% of patients and are more likely in women, brittle asthmatics and those with low paracetamol levels.
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Reactions can usually be controlled by simply stopping the infusion.
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If the reaction persists, 10 mg IV chlorphenamine can be given, and salbutamol nebulisers can be added if bronchospasm is present.
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