Maintenance of patency of Replogle tube

There are no reports of use of acetylcysteine for maintenance of patency of a Replogle tube used for suctioning of the proximal pouch in infants with oesophageal atresia.

In general, oral and rectal acetylcysteine use has been reported to be well tolerated, although the number of reports is insufficient to determine rates of adverse effects. Reported side effects of acetylcysteine treatment include hepatic derangement associated with use of oral acetylcysteine and acetylcysteine 0.2%/contrast enema in an infant with meconium ileus secondary to cystic fibrosis [14]; a preterm infant who developed hypernatraemia with instillation of a 5% solution through a distal stoma at 2.2 mL/hour [15]. There is also a case report of a 3-year-old infant with DIOS associated with cystic fibrosis, who developed liver injury after oral and rectal administration of acetylcysteine [16].

For paracetamol overdose, acetylcysteine is recommended at a dose of 300 mg/kg (200 mg/kg over 4 hours and 100 mg/kg over 16 hours) given intravenously. Adverse reactions are uncommon except for nausea and vomiting. Rashes, erythema, angioedema and anaphylaxis are uncommon [17].

Doses of acetylcysteine are comparable to those documented for paracetamol overdose and, with repeated administration orally or rectally, may substantially exceed these.