Paracetamol/diphenhydramine overdose
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Various toxicites: case report A 25-year-old woman experienced somnolence, minimum responsive to noxious stimuli, lactic acidosis, heart rate increased, blood pressure increased, blood glucose increased, elevated aspartate aminotransferase (AST) and exhibited paracetamol interference with glucose meter secondary to paracetamol toxicity following an overdose of paracetamol/diphenhydramine [dosage and duration of treatment to reactions onsets not stated]. The woman, who had a history of altered mental status, presented to the emergency department following an overdose of paracetamol/diphenhydramine [acetaminophen/diphenhydramine]. Approximately 1 hour prior to the presentation, she had ingested paracetamol/diphenhydramine. Upon arrival, she was noted to be somnolent with minimal responsive to noxious stimuli. Subsequently, the woman received naloxone treatment. However, her condition persisted. Initial examination revealed a heart rate of 126 beats/minutes, respiratory rate of 20 breaths/minute, blood pressure of 177/110mm Hg and body temperature was 350C. Bedside glucose measurement with five different StatStrip glucose meters showed an error message. Thereafter, orotracheal intubation was performed for airway protection. Her laboratory examination revealed lactic acidosis. Due to error in glucose meter test, a central laboratory performed glucose measurement test, which showed plasma glucose of 180 mg/dL. An interference of paracetamol with glucose meter test was thus considered. Additionally, her AST level was noted to be slightly elevated. Subsequent toxicology examination revealed an elevated level of paracetamol plasma concentration to 465 mg/L (drug toxicity). She was subsequently started receiving acetylcysteine via the orogastric tube. Following the acetylcysteine therapy, paracetamol plasma concentration decreased and her condition improved. After 17 hours from the presentation, her paracetamol plasma level became undetectable, and AST and lactate levels were noted to be normal. On day 2 of hospitalisation, she was extubated. After 24 hours, her acetylcysteine treatment was discontinued. After psychiatrist consultation, she was discharged from the hospital. Chenoweth JA, et al. Acetaminophen interference with Nova StatStrip Glucose Meter: case report with bench top confirmation. Clinical Toxicology 58: 1067-1070, No. 11, 803517445 Nov 2020. Available from: URL: http://doi.org/10.1080/15563650.2020.1732404
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Reactions 28 Nov 2020 No. 1832
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