Paracetamol overdose
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Paracetamol overdose Hepatic encephalopathy: case report
A 22-year-old woman developed hepatic encephalopathy following an overdose of paracetamol. The woman presented at 7am, with three days history of abdominal pain and vomiting, with recent onset of confusion. Initial vital signs revealed a tachycardia and hypoglycaemia. Hypoglycaemia was managed with IV dextrose. Examination showed jaundice, confusion and right upper-quadrant tenderness. The woman was treated with fluid resuscitation and dextrose. Despite normalisation of glucose, she remained confused. On further investigation it was found that she had taken overdose of paracetamol three days prior. She was diagnosed with suspected hepatic encephalopathy due to delayed paracetamol overdose. She was treated with acetylcysteine. Over the next eight hours, her mental state worsened, and she was intubated. An urgent CT brain scan showed cerebral oedema. Subsequently, she was shifted to ICU for ventilator support. She was managed with acetylcysteine, vitamin K, mannitol and fresh frozen plasma. Three days later, her mental state and laboratory investigation improved. She was discharged to general ward for a psychological assessment. On day 14, she was discharged from hospital without any mental impairment. Els JR, et al. Delayed presentation of paracetamol overdose. African Journal for Emergency Medicine 10: 170-172, No. 3, Sep 2020. Available from: URL: http:// doi.org/10.1016/j.afjem.2020.02.003
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Reactions 26 Sep 2020 No. 1823
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