Massive sulfasalazine and paracetamol ingestion causing acidosis, hyperglycemia, coagulopathy, and methemoglobinemia.
Reports of acute toxicity following sulfasalazine ingestion are rare. A case of an acute ingestion of sulfasalazine 50 g and paracetamol 50 g resulting in severe lactic acidosis, seizures, coagulopathy, hyperglycemia, ketosis, and methemoglobinemia is reported. Despite the ingestion of a large amount of paracetamol with serum paracetamol 5486 nmol/L (844 mg/L), significant hepatotoxicity did not occur. The patient recovered fully following administration of intravenous N-acetylcysteine, methylene blue, sodium bicarbonate, and supportive therapy.
Dunn
R J
RJ
University of Sydney, Department of Emergency Medicine, Canberra Hospital, Garran, ACT, Australia. RobvDunn@msn.com
D000082:Acetaminophen / Q000097:blood / Q000506:poisoning*; D000111:Acetylcysteine / Q000627:therapeutic use; D000140:Acidosis, Lactic / Q000139:chemically induced* / Q000188:drug therapy; D000208:Acute Disease; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000097:blood / Q000506:poisoning*; D001778:Blood Coagulation Disorders / Q000139:chemically induced* / Q000188:drug therapy; D001792:Blood Platelets / Q000187:drug effects; D004338:Drug Combinations; D062787:Drug Overdose / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D006943:Hyperglycemia / Q000139:chemically induced* / Q000188:drug therapy; D007262:Infusions, Intravenous; D008297:Male; D008708:Methemoglobinemia / Q000139:chemically induced* / Q000188:drug therapy; D008751:Methylene Blue / Q000627:therapeutic use; D010314:Partial Thromboplastin Time; D017693:Sodium Bicarbonate / Q000627:therapeutic use; D013406:Suicide, Attempted; D012460:Sulfasalazine / Q000097:blood / Q000506:poisoning*
D000893:Anti-Inflammatory Agents; D004338:Drug Combinations; D000082:Acetaminophen; D012460:Sulfasalazine; D017693:Sodium Bicarbonate; D008751:Methylene Blue; D000111:Acetylcysteine