N-acetylcysteine (NAC) is well known to emergency medicine physicians as the antidote in acute acetaminophen ingestion. The scope of use for this medication beyond that is often not considered, such as in other etiologies of acute liver failure like viral hepatitis, infection, autoimmune, etc.

As demonstrated by this meta-analysis, the data is difficult to come by, however, as more comes to light, the signal within suggests NAC has more to offer than just an antidote to acute liver failure in the setting of acetaminophen overdose.

Other causes of acute liver failure are inevitably going to present in the emergency department and acknowledging that NAC likely has a place in the care of these patients is important to consider.

As always, more data is needed, but with NAC’s low side effect profile and upside in the setting of acute liver injury and failure, it should at least be crossing the minds of emergency physicians early on for these patients.

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