NAC in Acute liver disease by Bharesh Dedhia

Bharesh dedhia
There is no doubt that N-acetylcysteine has saved countless lives in the management of paracetmol haepatotoxicty. In the first instance, this is due to the N-acetylcysteine acting replenishing stores of glutathione, which prevents hepatic damage by binding to a toxic metabolite of paracetamol. However, the effects of N-acetylcysteine seem to go beyond this, as there is evidence that continued infusion of N-acetylcysteine has beneficial effects in patients with established paracetamol induced hepatic damage, long after paracetamol has been cleared. Thus, the next logical step is to ask if N-acetylcysteine has a role in acute liver failure not caused by paracetamol. The papers discussed above have started the ball rolling in answering this, through several different approaches. Experimental evidence in rats would suggest there is a benefit, and two out three investigations show a beneficial effect of N-acetylcysteine on various physiological parameters in humans. These papers are however beset by the weaknesses described above. Perhaps more promising are the actual case reports of N-acetylcysteine playing a role in recovery from acute liver failure .These are, however, just isolated reports. One must remember that there may have been many times when N-acetylcysteine has been used but has failed to provide any benefit in the clinical setting. Such cases may not have been reported, thus creating a skewed view in the literature of only successful cases.
However it may be useful of try NAC in acute liver disease, as generally it is well tolerated. A large RCT would be helpful to settle the issue once and for all. Bharesh Dedhia