In Reply.—

Drs Walson and Groth are correct; the nomogram was designed to deal only with a single-point ingestion following a time interval sufficient to permit peak absorption.

It is critical to point out that current knowledge indicates continued dosing of N-acetylcysteine (NAC) (Mucomyst) very likely would have benefitted this patient. The reasons for this follow.

1. Smilkstein et al1 have reported previously that administration of NAC up to 24 hours after ingestion may have some, albeit reduced, benefits.

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