• PDF / 170,126 Bytes
• 1 Pages / 595.245 x 841.846 pts (A4) Page_size
• 87 Downloads / 193 Views

DOWNLOAD

REPORT

---

1 OS

Various toxicities: case report A 30-year-old woman developed gastric ulcer perforation during treatment with ibuprofen for dysmenorrhoea. Subsequently, she also developed high anion gap metabolic acidosis (HAGMA), pyroglutamic acid (PGA) accumulation and glutathione depletion following chronic misuse of paracetamol in overdose [dosages, routes and durations of treatments to reactions onsets not stated; not all outcomes stated]. The woman, who had dysmenorrhoea started receiving ibuprofen. However, following excessive use of ibuprofen, she developed gastric ulcer perforation. The woman therefore stopped ibuprofen, and started receiving oral modified release paracetamol tablets. She took 4 tablets every 3–4 hours. At the age of 32 years, she presented with ongoing pain from shingles [aetiology of shingles not stated] and was therefore hospitalised. Upon examination, she exhibited respiratory rate of 24/min. The pH of the venous blood gas was 7.04, pCO2 level was 19mm Hg, bicarbonate level was 5 mmol/L, sodium level was 150 mmol/L, anion gap was 28 and chloride level was 117 mmol/L. From laboratory tests, HAGMA was confirmed. After 2.5 hours of the last dose of paracetamol, serum paracetamol level was found to be 312 µmol/L, consistent with overdose of paracetamol. Thus, accumulation of pyroglutamic acid (PGA) due to chronic misuse of paracetamol and glutathione depletion was suspected. She was therefore treated with acetylcysteine along with sodium bicarbonate and unspecified IV crystalloids. This resulted in a complete resolution of HAGMA and she was discharged after 5 days. Lee HM, et al. An uncommon cause of highanion gap metabolic acidosis after repeated supratherapeutic paracetamol ingestion. Clinical Toxicology 58: 619, No. 6, 2020. 803502835 Available from: URL: http://doi.org/10.1080/15563650.2020.1741981 [abstract]

0114-9954/20/1823-0001/$14.95 Adis © 2020 Springer Nature Switzerland AG. All rights reserved

Reactions 26 Sep 2020 No. 1823