Case description: a 51yo woman known for bipolar disorder and BPD was admitted to ER after taking 100 pills of 1gr of paracetamol each. The ingestion of the pills was confirmed by the carabinieri and the blood works. The time btw the ingestion and 118’s intervention (3 hours) inhibited the gastrolusis’ efficacy. The Antipoison Centre suggested the oral administration of carbon (30gr,twice) and acetylcysteine in vein. According to the psychiatrists’ opinion she must be treated as a missed suicide. Meanwhile a therapy was suggested with an initial dose of 150mg/Kg (60kg, 30 doses) added to equal volume of 5% glucose solution in vein in 15 min. The following doses were 50mg/Kg in 4 hours and another dose of 100mg/kg in 16 hours, always in 5% glucose solution. The patient received, by mistake, further 4 doses of 50mg/Kg in 4 hours. The patient didn’t have any physical symptom or any liver consequences, in particular bilirubin and transaminases were monitored through blood check every 4 hours. No transaminase increase was found, nor any kidney function variation nor the emochrome. The check-ups continued over the following weeks.

Conclusions: We can, then, conclude that double administrations of acetylcysteine respect to those recommended by the guide lines are well tollerated and show a better detox effect  compared to the one expected from conventional doses.