PMID- 36273750
OWN - NLM
STAT- MEDLINE
DCOM- 20221206
LR  - 20221206
IS  - 1946-9837 (Electronic)
IS  - 1946-9837 (Linking)
VI  - 51
DP  - 2022 Nov-Dec
TI  - Anaphylaxis due to First-Time Intravenous Infusion of N-Acetylcysteine in a Dog.
PG  - 100734
LID - S1938-9736(22)00107-6 [pii]
LID - 10.1016/j.tcam.2022.100734 [doi]
AB  - A 4-year-old female spayed Pomeranian was referred to the emergency service for 
      intermittent trouble breathing and an enlarged liver found on ultrasound. A 
      severe mixed hepatopathy was found on bloodwork, and ultrasound-guided liver 
      aspirates showed marked hepatocellular vacuolar changes and rare neutrophils. An 
      intravenous (IV) loading dose of n-acetylcysteine (NAC) was given for the first 
      time in this patient, and immediately after the infusion the patient collapsed, 
      became hypotensive, hypothermic, tachycardic, and developed gallbladder wall 
      edema. Treatment for anaphylaxis was immediately initiated with IV fluids, an 
      epinephrine bolus and then continuous rate infusion, diphenhydramine, and 
      famotidine. Clinical signs resolved within an hour of treatment with no 
      recurrence. The hepatic enzymopathy improved, and the patient was ultimately 
      diagnosed with a steroid hepatopathy based on laparoscopic liver biopsies. 
      Anaphylaxis caused by first-time administration of IV NAC in a dog has not 
      previously been reported, though it is known to occur in humans. Based on this 
      report, it would be clinically wise to give careful consideration before 
      prescribing NAC in cases where it is not a specific antidote or if other options 
      are available, and to closely monitor the patient during and immediately after 
      administration.
CI  - Copyright (c) 2022 Elsevier Inc. All rights reserved.
FAU - Gregory, Elizabeth A
AU  - Gregory EA
AD  - Department of Small Animal Clinical Sciences, Veterinary Medical Center, Michigan 
      State University, East Lansing, MI, USA.
FAU - Binagia, Erin M
AU  - Binagia EM
AD  - Department of Small Animal Clinical Sciences, Veterinary Medical Center, Michigan 
      State University, East Lansing, MI, USA. Electronic address: 
      embinagiadvm@gmail.com.
LA  - eng
PT  - Case Reports
DEP - 20221020
PL  - United States
TA  - Top Companion Anim Med
JT  - Topics in companion animal medicine
JID - 101465592
RN  - WYQ7N0BPYC (Acetylcysteine)
RN  - 8GTS82S83M (Diphenhydramine)
RN  - YKH834O4BH (Epinephrine)
SB  - IM
MH  - Humans
MH  - Female
MH  - Dogs
MH  - Animals
MH  - Acetylcysteine/therapeutic use
MH  - *Anaphylaxis/chemically induced/drug therapy/veterinary
MH  - Infusions, Intravenous/veterinary
MH  - Diphenhydramine/therapeutic use
MH  - Epinephrine
MH  - *Dog Diseases/chemically induced/drug therapy
OTO - NOTNLM
OT  - N-acetylcysteine
OT  - anaphylactoid
OT  - anaphylaxis
OT  - canine
OT  - hypersensitivity
OT  - nonimmunologic
EDAT- 2022/10/24 06:00
MHDA- 2022/12/07 06:00
CRDT- 2022/10/23 19:36
PHST- 2022/04/27 00:00 [received]
PHST- 2022/08/23 00:00 [revised]
PHST- 2022/10/14 00:00 [accepted]
PHST- 2022/10/24 06:00 [pubmed]
PHST- 2022/12/07 06:00 [medline]
PHST- 2022/10/23 19:36 [entrez]
AID - S1938-9736(22)00107-6 [pii]
AID - 10.1016/j.tcam.2022.100734 [doi]
PST - ppublish
SO  - Top Companion Anim Med. 2022 Nov-Dec;51:100734. doi: 10.1016/j.tcam.2022.100734. 
      Epub 2022 Oct 20.