Neonatal Drug Therapy Manual


Disclaimer: Official controlled document is the CHEO and Ottawa Hospital online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
Original Date: 
June 2010
  • Distal intestinal obstruction syndrome (previously known as meconium ileus)
  • PO
  • PR
  • Intra operatively via local instillation

Acetylcysteine 5 % Oral or Enema Solution

  • PO: 5 - 10 mL Q6H
  • PR: 10 mL/kg Q6H (up to 45 mL q6H)

Intra operative wash of distal ileum:

Procedure done using normal saline and 2 - 4 % acetylcysteine solution (by diluting available 20% N-acetylcysteine with sterile water)


Side Effects: 
  • Endocrine and metabolic: hypernatremia
  • GI: dyspepsia, nausea, vomiting
  • Hepatic: increase in transaminases and bilirubin
Parameters to Monitor: 
  • Serum sodium
  • Liver function tests
Reconstitution and Stability: 
  • Acetylcysteine 200 mg/mL (20%)
    • Withdraw 5 mL
    • Add to 15 mL of 0.9% NaCl
    • Final Concentration: Acetylcysteine 5%
  • Acetylcysteine 200 mg/mL (20%)
    • Withdraw 10 mL
    • Add to 40 mL of sterile water
    • Final Concentration: Acetylcysteine 4%



Rectal enemas of Acetylcysteine appear to have less favorable results than oral administration


-Bhattacharyaya S, BasuKS, Samanta N.  Proximal bowel T-tube drainage and local instillation of N-acetyl cysteine: A modified approach to management of meconium ileus.  J Indian Assoc Pediatr Surg 2005; 10: 37-40

-Emil S, Nguyen T, Sills J, et al:  Meconium obstruction in extremely low-birth-weight neonates: guidelines for diagnosis and management.  J Pediatr Surg 2004; 39 (5): 731-737

-Cooke A, Deshpande AV, Wong CKF and al: Hepatic derangement following N-Acetylcysteine enemas in an infant with cystic fibrosis.  Journal of Paediatrics and Child Health 2008; 44: 673 - 675


The information contained on this website is provided for informational purposes only, as a guide to assist physicians, nurses and other healthcare providers in deciding on the appropriate care required for a particular patient. At all times, physicians, nurses and other healthcare providers must exercise their independent clinical judgment, based on their knowledge, training and experience, taking into account the specific facts and circumstances of each patient, when deciding on the appropriate course of investigation and/or treatment to recommend in a particular clinical situation.

CHEO has made every effort to ensure that the information contained on this website is as current and accurate as possible. However, changes can occur due to ongoing research and the constant influx of new information. Where possible, hospitals and healthcare practitioners should verify the information before acting on it.

Reliance on any information in this website is at the user's own risk. CHEO is not responsible or liable for any harm, loss or other consequences from the use or misuse of the information on this website.