title: [A case of paracetamol retard poisoning with fatal outcome].
abstract: A case of fatal paracetamol (acetaminophen) poisoning in a 26-year-old woman who developed liver necrosis is described. The patient reported having ingested 11 g of a slow-release paracetamol preparation and a certain amount of alcohol and benzodiazepine. An unknown dose of phenobarbital (phenemal) had been ingested 24 hours previously, leading to a serum phenobarbital concentration of 0.195 mmol/l at the time of admission. The patient was initially treated with N-acetylcysteine intravenously. This treatment was discontinued after five hours due to a serum paracetamol concentration of 0.49 mmol/l, well below the "treatment line" paracetamol concentration of 0.8 mmol/l six hours after ingestion. Possible aggravating factors are discussed, including sustained high serum concentration of paracetamol due to the slow-release preparation and enzyme induction caused from concomitant phenobarbital and alcohol intake, as well as benzodiazepines displacing paracetamol from liver enzymes. These factors make serum paracetamol concentrations undependable; the importance of continuing N-acetylcysteine treatment in spite of "safe" serum concentrations in the above cases is stressed.
authors.affiliation: Medicinsk afdeling C, Amtssygehuset i Glostrup.
authors.forename: B B
authors.initials: BB
authors.lastname: Lystbaek
authors.forename: P
authors.initials: P
authors.lastname: Nørregaard
mesh_terms: D000082:Acetaminophen / Q000506:poisoning*; D000328:Adult; D003692:Delayed-Action Preparations; D062787:Drug Overdose; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008099:Liver / Q000187:drug effects; D009336:Necrosis; D013405:Suicide
chemical_list: D003692:Delayed-Action Preparations; D000082:Acetaminophen