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A double-blind randomized controlled trial of 177 patients with renal insufficiency undergoing cardiac surgery reported that N-acetylcysteine treatment (100 mg/kg bolus followed by 20 mg/kg/hr infusion) was associated with significantly greater blood loss and a requirement of 1.6 more units of blood transfusion (95% CI, 0.4-3.1 units) (32)

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It also raises stress hormones, which lowers glutathione action in a roundabout way

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