Open AccessA quarter pound of acetaminophen with propylene glycol on the side: A case report
Author(s) -
Daniel P. Murphy,
Abrar Ahmad Khan,
Christine Borscheid,
Samy Riad
Publication year - 2020
Publication title -
clinical nephrology - case studies
Language(s) - English
Resource type - Journals
ISSN - 2196-5293
DOI - 10.5414/cncs109936
Subject(s) - acetaminophen , acetylcysteine , acetaminophen overdose , medicine , antidote , hemodialysis , drug overdose , dialysis , dosing , anesthesia , toxicity , intensive care medicine , pharmacology , surgery , emergency medicine , poison control , chemistry , biochemistry , antioxidant
Particularly large acetaminophen overdoses, termed massive, create a therapeutic challenge given the standardized, N-acetylcysteine-based treatment. One consideration in addition to N-acetylcysteine is the initiation of hemodialysis due to the dialyzable nature of acetaminophen, though encumbered by the concurrent removal of the antidote, N-acetylcysteine. Such cases of large acetaminophen overdose, along with possible concomitant ingestions of other drugs or inactive ingredients, can be complicated by challenging-to-interpret clinical signs and laboratory findings. We describe a case of a 46-year-old man for whom we were consulted regarding consideration of dialysis treatment 7 hours after ingestion of 125 g of acetaminophen. The patient developed multiple early signs and laboratory findings consistent with a significant acetaminophen overdose. He also developed a rarely described, likely acetaminophen-interference-induced laboratory abnormality. Finally, he possibly had toxicity from an "inactive" ingredient. He was treated with a single session of prolonged hemodialysis (9.5 hours) and increased dosing of N-acetylcysteine with a positive outcome. Herein, we discuss the decision making and interpretation of clinical data pertaining to dialysis treatment and other therapies after a massive acetaminophen overdose.