Antidotal therapy has been used in two cases of intentional exposure to T61® where reduced glutathione (Trevisani et al., 1993) and acetylcysteine (Buylaert et al., 1996) were given. However, it is not clear from these cases whether it was of any benefit in protecting the liver.

Experiments in rats measuring the effect of acetylcysteine on the concentration of the liver enzyme sorbitol dehydrogenase (SDH) (the most specific indicator of hepatotoxicity in rats) demonstrated a lower rise in SDH in acetylcysteine treated animals. However, this difference was only significant when the data of four series were pooled. This suggests a small or non-existent protective effect of acetylcysteine but may have been due to large inter-individual variations in the effects of dimethylformamide. It should be noted, however, that in these experiments acetylcysteine was given prior to exposure to DMF which does not reflect the clinical situation (Buylaert et al., 1996).

From these data it is unclear whether acetylcysteine has a protective effect in DMF poisoning. However, it is relatively safe and easily available and should be considered for serious DMF poisoning.

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