Hemolysis after acetaminophen overdose in a patient with glucose-6-phosphate dehydrogenase deficiency.
METHODS
A sixteen year-old-male with a history of glucose-6-phosphate dehydrogenase deficiency ingested an unknown amount of acetaminophen and presented to an emergency department 7.5 h later. He was afebrile. His serum acetaminophen level was 184 micrograms/mL, and his urine toxicologic screen was otherwise negative. Vomiting led to enrollment in a experimental protocol of intravenous N-acetylcysteine. He developed no evidence of subsequent chemical hepatitis but did develop a significant Coomb's negative hemolytic anemia. Hemoglobin on presentation was 14 g/dL and reached a nadir of 9.4 g/dL on admission day 4.


CONCLUSIONS
Patients with glucose-6-phosphate dehydrogenase deficiency who overdose with acetaminophen should be monitored for the possible development of subsequent drug-induced hemolysis.
Wright
R O
RO
Harvard University Medical School, Department of Medicine, Boston, Massachusetts, USA.
Perry
H E
HE
Woolf
A D
AD
Shannon
M W
MW
D000082:Acetaminophen / Q000506:poisoning*; D000111:Acetylcysteine / Q000008:administration & dosage / Q000627:therapeutic use; D000293:Adolescent; D005955:Glucosephosphate Dehydrogenase Deficiency / Q000150:complications*; D006454:Hemoglobins / Q000032:analysis; D006461:Hemolysis / Q000187:drug effects*; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D011041:Poisoning / Q000150:complications* / Q000188:drug therapy; D013405:Suicide
D006454:Hemoglobins; D000082:Acetaminophen; D000111:Acetylcysteine