Protocol change: Intravenous N-Acetylcysteine (NAC) for acetaminophen overdose
The BC Drug and Poison Information Centre is transitioning to a new standardized protocol for the management of acetaminophen overdose with Intravenous N-acetylcysteine (NAC). This protocol applies to adult and pediatric patients. Full details of new protocol. [link to .pdf document]
The Revised Pan-Canadian NAC Protocol (1-concentration/2-step)
The revised protocol provides clear, consistent direction for all institutions and delivers a higher total dose of NAC (450 mg/kg over the first 21 hours vs. 300 mg/kg) providing greater protection in cases of massive overdose or with established hepatotoxicity.
| Parameter | Standardized Requirement |
|---|---|
| Solution concentration | 3% (30 mg/mL) NAC solution |
| Diluent | D5W preferred; ½ NS or NS acceptable |
| Step 1 — loading dose | 150 mg/kg over 1 hour |
| Step 2 — maintenance | 15 mg/kg/hour, continuous, for a minimum of 20 hours |
Implementation at Island Health
- Island Health will transition to the new protocol on September 15, 2026, ahead of the province-wide target date of November 1, 2026.
- Pharmacy and clinical teams are aligning local resources (order sets, infusion references, and pre-printed orders) with the standardized protocol.
- The traditional three-bag order sets (CPOE and paper) will no longer be available after the launch date.
Questions
The BC Drug and Poison Information Centre provides 24/7 support to support clinicians during the protocol transition. Call 1‑800‑567‑8911 for advice on cases of suspected or confirmed acetaminophen poisoning, or for questions about the revised protocol.
Quick reference infographics and full protocol information is available for download to print and/or post in clinical areas.