Safety and Efficacy of the SNAP 12-hour Acetylcysteine Regimen for the Treatment of Paracetamol Overdose – [LINK HERE]

Wed 16th Dec 12-13:00

TEAMS meeting

• Everyone is welcome – Nursing and medical, no experience necessary
• Read the article  – check your emails
  • (we have emailed out to you – if not, email darren or huw and we will send a copy)
• Your opinion – Whats good and bad about the study, would this change your practice?
• Come along – We will discuss; how to read a paper, what everyone thinks about the paper
• if you can’t make it – feel free to post your thoughts below so we can bring them up

Outcome

Pros

• Highly relevant to practice in the ED
• Used a UK ED population
• Large sample size
• Usedall patients attending with paracetamol overdose requiring treatment
• Good Follow-Up

Cons

• Using 2 separate cohorts that span 2 yrs, may be convenient but may hide significant differences in both population and hospital practice
• Anaphylactoid definition “patient prescribed antihistamine” , again convenient but prob not accurate
  • The amount of anaphylactoid reactions reported seems excessive compared to our experience (but is this because they occur more frequently outside the ED)
• One of the aims was to examine effectiveness invarious overdose types (e.g. delayed presentation, staggerd overdose), but didn’t have the numbers for subgroup analysis
• More staggered overdoes in the 12hr SNAP group – was this a function of teaching in preparation to changing protocol or was it truly different?

Overall

• We agreed that the 12hr SNAP protocol seems to be an effective alternative to the current 21hr regime in preventing liver damage.

Further question generated

• All patients meant to have bloods done at 24hrs? – good for internal validity but if put into practice negates the major benefit of the 12hr regime
• Data on Children? – we would like to know it’s effective in a paediatric population (as do we want 2 regimes and the chance of error)
• Is 21hr regime more effective? – it was postulated in the paper late presentations have a poorer outcome. There were significantly more late presentations in the 21hr group, but no difference in overall effectiveness (so is 21hr better?)
• Extended 12hr regime? – we couldn’t see how many patients in the 12hr SNAP group had their treatment extended upto 21hr  (only beyond 21hr).
• Excess repeat overdose? – in the 12hr SNAP group there was a significant 2.1% increase in repeat overdoses. Did reducing the side-effect profile and length of antidote encourage repeat overdose? OR were we seeing a variance in population behavior.