Making Acetylcysteine bearable?

Nurses General Nursing

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Any suggestions or tricks? Administered by nebulizer as a respiratory treatment, not orally.

Thanks in advance. It seems this is the only mucolytic administered via HHN.

My apologies ;) I read it wrong. Sorry.

All good, not a problem. Cheers.

"Yes, but the OP asked about concepts specific to the nebulised route not the oral route. My response was specific to the original question. Regarding oral use for APAP toxicity, an IV formulation exists and I would urge people to push for using this instead of the original formulation."

This IS what I asked GilaRN and I appreciate your very pertinent reply. The oral use of Mucomyst I have seen most frequently is off-label, to reduce the effects of contrast on the kidneys. But honestly, at the moment, I just appreciate you answering my original question ... And am working on accepting this intolerable smell.

If it bugs you, try a few swipes of an alcohol wipe under the nose. It can be unpleasant, but makes smells more tolerable. On occasion, I wiped a little Vicks under the nose when I had morgue duty in Kabul. Not recommended perhaps, but it helped me through a couple of particularly bad days...

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Have you tried juice in the nebulizer? j/k

While I've not ever done nebs (RT does them at my facility), I'm just trying to think through what I've done to mask smells in the past, the best I can think of is maybe have them suck on a life saver or other pungent hard candy during admin. Again, no experience, just trying to think of options.

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"If it bugs you, try a few swipes of an alcohol wipe under the nose. It can be unpleasant, but makes smells more tolerable. On occasion, I wiped a little Vicks under the nose when I had morgue duty in Kabul. Not recommended perhaps, but it helped me through a couple of particularly bad days.."

Thanks, I will see if this helps, its really hard to get cooperation and we are all suffering in the process. And thanks for the information, the MD who prescribed the treatment wrote it "by nebulizer as directed" ... except she didn't "direct" anything (she was NOT aware I am an RN). I feel there is a lot of misunderstanding about neb treatments because RT handles them on most units. In my humble opinion, they aren't always treated with the respect they deserve in regards to patient education, especially in regards to bronchospasm and tachycardia.

Simboka: No go for a person on aspiration precautions, but that's a great suggestion. And thank you truly for making me laugh envisioning grape aerosol!

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
I don't know about via neb, but as PO grape juice or coke help mask the flavor.

It's the smell that most people can't tolerate.

If for tylenol overdose to be taken po. The manufacturer states that it has to be in a cola type liquid for maxim effectivenes. Mucumist can also be given IV and I believe has been approved for general use by the FDA. Protocol can be found at the "Rocky Montain Spotter fever center" in colorado. As for HHn.....in 30 years it has always smelled of rotten eggs, still smells of rotten eggs, and unfortunately will always smell like rotten eggs.:crying2: Try vicks in your nose and under your nose, with of without a mask.......that has worked for some amazing smells that have crossed my path in 30 years! lol

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Thanks all for the advice, I care a lot more about the person using it then I do about my own disdain for the smell. I'll give Vix a try

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Strange. I gave neb treatments with mucomyst for about three years to a home health patient and I can not recall ever discovering that it smells like rotten eggs. My sinus problems must have finally been of good use.

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An aside for nurses mixing with soda for PO mucomyst (yes I know not the original q)...

That fizz is CO2. And extra CO2 loading probably isn't the best thing if the patient is also a CO2 retaining COPD'er. Just a thought...

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An aside for nurses mixing with soda for PO mucomyst (yes I know not the original q)...

That fizz is CO2. And extra CO2 loading probably isn't the best thing if the patient is also a CO2 retaining COPD'er. Just a thought...

GI versus pulmonary, however.

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The CO2 is still absorbed into the blood stream by the intestines, and is therefore primarily eliminated by the lungs, the extra CO2 absorbed via the intestinal track will signal the central chemoreceptors to "immediately" increase the respiratory rate.

No problem for a 'normal' person, but, for a patient who already has a compromised respiratory system, such as symptomatic asthmatics and chronic lung patients, they may not have the lung capacity to increase their respiratory rate enough to 'blow off' the extra CO2, and this may cause additional dyspnea and aggravate respiratory failure.

Carbonated beverages can also cause excess gas and bloating, which may result in the diaphragm being pushed up against the lungs, further compromising them and making it even more difficult to breathe.

Just a thought for the emergent side of your skill set...

You have the concerned relative of an asthmatic in severe respiratory distress with no meds or rescue inhaler on the line with a long wait to arrival of the bus.. would you recommend PO caffeinated coffee or would you recommend PO caffeinated cola?

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I can buy your concern on a theoritical basis; however, I am unaware of any good randomized, prospective evidence that states COPD patients are more likely to go into respiratory distress because they took a dose of Mucomyst that happened to be diluted in a bit of soda?

The asthma question is yet another somewhat theoretical scenario. In studies that I have seen where there was some benefit, the doses given were rather large, on the order of 5-10 mg/kg. The truth being, that in my area of the country, we are not allowed to give advice over the phone other than to call 911.

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I can buy your concern on a theoritical basis; however, I am unaware of any good randomized, prospective evidence that states COPD patients are more likely to go into respiratory distress because they took a dose of Mucomyst that happened to be diluted in a bit of soda?

The asthma question is yet another somewhat theoretical scenario. In studies that I have seen where there was some benefit, the doses given were rather large, on the order of 5-10 mg/kg. The truth being, that in my area of the country, we are not allowed to give advice over the phone other than to call 911.

Just an aside: It is refreshing to read a clinical thread in which the participants disagreed on a civil level, and I learned something.

Thanks!

Oldeibutgoodie

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Specializes in LTC/Rehab, Med Surg, Home Care.

Would love to see the research that says that the CO2 in soda is absorbed enough to the point where it can impact the respiratory system in a COPD'er. I'm also curious how much of the carbonated beverage would have to be consumed in order for this scenario to occur.

I'm not going to comment on the excess gas/bloating making it more difficult to breath as a result of pressure on the diaphragm. None of my pts. have ever had an issue with *NOT* being able to release gas. Most tend to do it while I'm in the room, assisting with cares :-)

In the scenario below, I'd tell them to call 911 if the pt. is in distress.

The CO2 is still absorbed into the blood stream by the intestines, and is therefore primarily eliminated by the lungs, the extra CO2 absorbed via the intestinal track will signal the central chemoreceptors to "immediately" increase the respiratory rate.

No problem for a 'normal' person, but, for a patient who already has a compromised respiratory system, such as symptomatic asthmatics and chronic lung patients, they may not have the lung capacity to increase their respiratory rate enough to 'blow off' the extra CO2, and this may cause additional dyspnea and aggravate respiratory failure.

Carbonated beverages can also cause excess gas and bloating, which may result in the diaphragm being pushed up against the lungs, further compromising them and making it even more difficult to breathe.

Just a thought for the emergent side of your skill set...

You have the concerned relative of an asthmatic in severe respiratory distress with no meds or rescue inhaler on the line with a long wait to arrival of the bus.. would you recommend PO caffeinated coffee or would you recommend PO caffeinated cola?

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