Acetylcysteine/paracetamol

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Acetylcysteine/paracetamol Various toxicities due to paracetamol overdose, and lack of efficacy: case report

A 23-year-old man developed epigastric complaints, hepatotoxicity and acute tubular necrosis with oedema due to drug intoxication following an overdose of paracetamol. He also exhibited a lack of efficacy during treatment with acetylcysteine for paracetamol intoxication [not all dosages, times to reactions onsets and outcomes stated]. The man presented to the emergency department because of epigastric complaints. Twenty four hours prior to the presentation, he had ingested 10g of immediate-release paracetamol [acetaminophen] over a 6h period (drug overdose). At the current presentation, his clinical examination was normal. Initial laboratory test results revealed increased liver function tests, while his renal functions were normal. A coagulation test results were disturbed with an INR of 1.44. Twenty-three hours after intoxication, his serum paracetamol level was 28.6 mg/L, indicative of paracetamol toxicity. As per the Rumack-Matthew nomogram, paracetamol-induced hepatotoxicity was suspected. Hence, the man started receiving acetylcysteine [N-acetylcysteine]. Further toxicological investigation showed the presence of paracetamol, while urine analysis was negative. Subsequently, he was transferred to the ICU. Two days after ICU admission, his kidney functions rapidly decreased. Nine days after paracetamol intoxication, his estimated glomerular filtration rate also decreased. Hence, haemodialysis was initiated. Ten days after paracetamol intoxication, no improvement in kidney function was noted. The renal biopsy revealed acute tubular necrosis with oedema because of paracetamol toxicity. Afterwards, he was discharged from the hospital. One week after discharge from the hospital, his kidney function improved. Eeckhout K, et al. Acute kidney failure due to acetaminophen overdose: A case report. Clinical Toxicology 58: 622, No. 6, Jan 2020. Available from: URL: http:// doi.org/10.1080/15563650.2020.1741981 [abstract]

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Reactions 26 Sep 2020 No. 1823

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