A gargantuan acetaminophen level in an acidemic patient treated solely with intravenous N-acetylcysteine

American Journal of Therapeutics

Volumn 20, Issue 1, 2013, Pages 104-106

  Zell Kanter, Michele ^b   Coleman, Patrick ^a   Whiteley, Patrick M ^b   Leikin, Jerrold B ^c  

^a NORTHWESTERN UNIVERSITY   (United States)

^b Division of Medical Toxicology   (United States)

^c NORTHSHORE UNIVERSITY HEALTHSYSTEM   (United States)

Author keywords

acetaminophen overdose; acidosis; N acetylcysteine

Indexed keywords

ACETYLCYSTEINE; ACTIVATED CARBON; ALANINE AMINOTRANSFERASE; AMINOTRANSFERASE; ASPARTATE AMINOTRANSFERASE; BICARBONATE; PARACETAMOL; PHOSPHOTRANSFERASE;

ACIDEMIA; ADULT; ARTICLE; CASE REPORT; COMA; CONTINUOUS INFUSION; DEPRESSION; DRUG BLOOD LEVEL; DRUG INTOXICATION; DRUG URINE LEVEL; FEMALE; HUMAN; INTUBATION; PRIORITY JOURNAL; QT PROLONGATION; SUICIDE;

ACETAMINOPHEN; ACETYLCYSTEINE; ACIDOSIS; ANALGESICS, NON-NARCOTIC; ANTIDOTES; DRUG OVERDOSE; FEMALE; HUMANS; INFUSIONS, INTRAVENOUS; MIDDLE AGED; SUICIDE, ATTEMPTED;

EID: 84872920821     PISSN: 10752765     EISSN: 15363686     Source Type: Journal    
DOI: 10.1097/MJT.0b013e3181ff7ac0     Document Type: Article

References (17)

1. Koulouris Z, Tierney MG, Jones G. Metabolic acidosis and coma following a severe acetaminophen overdose. Ann Pharmacother. 1999;33:1191-1194
2. Roth B, Woo O, Blanc P. Early metabolic acidosis and coma after acetaminophen ingestion. Ann Emerg Med. 1999;33:452-456 (Pubitemid 29157573)
3. Steelman R, Goodman A, Biswas S, et al. Metabolic acidosis and coma in a child with acetaminophen toxicity. Clin Pediatr. 2004;43:201-203 (Pubitemid 38299080)
4. Mendoza CD, Heard K, Dart RC. Coma, metabolic acidosis and normal liver function in a child with a large serum acetaminophen level. Ann Emerg Med. 2006; 48:637 (Pubitemid 44556901)
5. Lieh-Lai MW, Sarnaik AP, Newton JF, et al. Metabolism and pharmacokinetics of acetaminophen in a severely poisoned child. J Pediatr. 1984;105:125-128 (Pubitemid 14086286)
6. Doyon S, Klein-Schwartz W. Hepatotoxicity despite early administration of intravenous N-Acetylcysteine for acute acetaminophen overdose. Acad Emerg Med. 2009; 16:34-39
7. Porter KE, Dawson AG. Inhibition of respiration and gluconeogenesis by paracetamol in rat kidney preparations. Biochem Pharmacol. 1979;28:3057-3062 (Pubitemid 10191843)
8. Caldwell J, Woods HF. Metabolic consequences of the short-Term exposure of the liver to paracetamol. Clin Sci. 1978;55:P10-P11
9. Gray TA, Buckley BM, Vale JA. Hyperlactataemia and metabolic acidosis following paracetamol overdose. Q J Med. 1987;65:811-821 (Pubitemid 18012574)
10. Product Information: ACETADOTE- IV injection, acetylcysteine IV injection. Cumberland Pharmaceuticals. Inc. Nashville, TN; 2008
11. Flanagan RJ, Mant TGK. Coma and metabolic acidosis early in severe acute paracetamol poisoning. Human Toxicol. 1986;5:179-182 (Pubitemid 16100140)
12. Vale JA, Meredith TJ. Metabolic acidosis in paracetamol poisoning. Br Med J. 1982;285:1208 (Pubitemid 12029750)
13. Schwartz EA, Hayes BD, Sarmiento KF. Development of hepatic failure despite use of intravenous acetylcysteine after a massive ingestion of acetaminophen and diphenhydramine. Ann Emerg Med. 2009;16:34-39
14. Zezulka A, Wright N. Severe metabolic acidosis early in paracetamol poisoning. Br Med J. 1982;285:851-852 (Pubitemid 12067731)
15. Wiegand TJ, Margaretten M, Olson KR. Massive acetaminophen ingestion with early metabolic acidosis and coma: Treatment with IV NAC and continuous venovenous hemodiafiltration. Clin Toxicol. 2010;48:156-159
16. Kirk M, Selden B, Kulig K. Serum N-Acetylcysteine levels during hemodialysis. Vet Hum Toxicol. 1992;34:327
17. Cantrell L, Shah N, Anderson PO, et al. Assessing the influence of Acetadote on use of intravenous N-Acetyl cysteine for acetaminophen poisonings. Hosp Pharm. 2009; 44:491-496