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Demonstrates adverse reactions linked to hypertonicity in acetylcysteine nebulized solutions, indicating safer diluent options.
The relative tonicities of several concentrations of acetylcysteine solutions and several concentrations of sodium chloride solutions were measured, using the Fiske Model 230-D Research Osmometer. Concentrations of sodium chloride solutions osmotically equivalent to commercially available acetylcysteine solutions were determined. Aqueous solutions of 4.2% and 9.4% sodium chloride are osmotically equivalent to solutions of 10% and 20% acetylcysteine (neutralized with sodium hydroxide to pH 7.0) respectively. The results suggest that many adverse reactions to inhaled nebulized solutions of acetylcysteine result from hypertonicity rather than from acetylcysteine per se. Sterile water and not saline should be the diluent for aerosol solutions of acetylcysteine, to minimize the toxicity of the final solution and thus the potential for increased airways resistance.
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Cato et al. (1977) studied this question.
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