A Case Report of Massive Acetaminophen Poisoning Treated with a Novel “Triple Therapy”: N-Acetylcysteine, 4-Methylpyrazole, and Hemodialysis
Joint Authors
Katz, Kenneth
Kiernan, Emily A.
Fritzges, Julie A.
Henry, Kathryn A.
Source
Case Reports in Emergency Medicine
Issue
Vol. 2019, Issue 2019 (31 Dec. 2019), pp.1-4, 4 p.
Publisher
Hindawi Publishing Corporation
Publication Date
2019-03-05
Country of Publication
Egypt
No. of Pages
4
Main Subjects
Abstract EN
Massive acetaminophen (N-acetyl-p-aminophenol; APAP) ingestion is characterized by a rapid onset of mitochondrial dysfunction, including metabolic acidosis, lactemia, and altered mental status without hepatotoxicity which may not respond to the standard doses of N-acetylcysteine (NAC).
A 64-year-old woman without medical history presented comatose after an ingestion of 208 tablets of Tylenol PM™ (APAP 500 mg and diphenhydramine 25 mg).
The initial APAP concentration measured 1,017 µg/mL (therapeutic range 10-30 µg/mL), and elevated anion gap metabolic acidosis, lactemia, and 5-oxoprolinemia were detected.
High-dose intravenous (IV) NAC, 4-methylpyrazole (4-MP), and hemodialysis (HD) were initiated.
She was transferred to a liver transplant center and continued both NAC and HD therapies until complete resolution of metabolic acidosis and coma without developing hepatitis.
She was discharged without sequelae.
This is the fourth highest APAP concentration recorded in a surviving patient.
Moreover, this is the first report of a novel “triple therapy” using NAC, 4-MP, and HD in the setting of massive APAP ingestion that presents with coma, elevated anion gap metabolic acidosis, and lactemia.
Emergency physicians should recognize these critically ill patients and consider high-dose NAC, 4-MP, and HD to be initiated in the emergency department (ED).
American Psychological Association (APA)
Kiernan, Emily A.& Fritzges, Julie A.& Henry, Kathryn A.& Katz, Kenneth. 2019. A Case Report of Massive Acetaminophen Poisoning Treated with a Novel “Triple Therapy”: N-Acetylcysteine, 4-Methylpyrazole, and Hemodialysis. Case Reports in Emergency Medicine،Vol. 2019, no. 2019, pp.1-4.
https://search.emarefa.net/detail/BIM-1135986
Modern Language Association (MLA)
Kiernan, Emily A.…[et al.]. A Case Report of Massive Acetaminophen Poisoning Treated with a Novel “Triple Therapy”: N-Acetylcysteine, 4-Methylpyrazole, and Hemodialysis. Case Reports in Emergency Medicine No. 2019 (2019), pp.1-4.
https://search.emarefa.net/detail/BIM-1135986
American Medical Association (AMA)
Kiernan, Emily A.& Fritzges, Julie A.& Henry, Kathryn A.& Katz, Kenneth. A Case Report of Massive Acetaminophen Poisoning Treated with a Novel “Triple Therapy”: N-Acetylcysteine, 4-Methylpyrazole, and Hemodialysis. Case Reports in Emergency Medicine. 2019. Vol. 2019, no. 2019, pp.1-4.
https://search.emarefa.net/detail/BIM-1135986
Data Type
Journal Articles
Language
English
Notes
Includes bibliographical references
Record ID
BIM-1135986