Paracetamol overdose
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Fatal multiple organ failure: case report A 43-year-old man with a history of extensive alcohol intake developed liver failure, renal impairment and metabolic acidosis after a paracetamol [acetaminophen] overdose and subsequently died of multiple organ failure. The man had taken a large amount of paracetamol [dosage and duration of therapy not stated] for ear pain associated with cellulitis. Approximately 24 hours after last ingesting paracetamol, he presented with jaundice and increasing confusion and agitation. Investigations revealed the following abnormalities: haemoglobin 16.2 g/dL, WBC count 7.2 x 109/L, platelets 117 x 109/L, alkaline phosphatase 168 U/L, AST more than 18,000 U/L (normal 12–31), ALT more than 5000 U/L (10–45), total bilirubin 7 mg/dL, INR 4.0 and creatinine 3.6 mg/dL (0.9–1.4). He also had an increased anion gap metabolic acidosis, proteinuria and microscopic haematuria. Examination revealed tachypnoea, tachycardia, asterixis, abdominal tenderness and distention, lower gastrointestinal bleeding and ascites. His paracetamol level was found to be 28 µg/mL. The man was treated with IV antibacterials and acetylcysteine and a Foley catheter was inserted to assess urine output. His clinical status continued to deteriorate and he developed multiple organ failure. Medical support was withdrawn and he died 2 days later. Author comment: "[P]hysicians should be cognizant about the use of [paracetamol] or [paracetamol] combination preparations by their patients and of any predisposing factors, such as long-term alcohol use, that may increase their risk for toxicity." Anavekar NS, et al. 43-Year-old man with ear pain, confusion, and agitation. 801013673 Mayo Clinic Proceedings 81: 1096-1099, No. 8, Aug 2006 - USA
0114-9954/10/1123-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 14 Oct 2006 No. 1123
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