Persistently elevated acetaminophen concentrations for two days after an initial four-hour non-toxic concentration.
The decision to treat patients who overdose with n-acetylcysteine is routinely made with a single APAP concentration drawn 4 or more hours post-ingestion. However, in cases where there are co-ingestants that may delay gastric emptying, there have been recommendations for additional concentrations to determine peak APAP concentrations. This report is of a case of acetaminophen overdose involving narcotic co-ingestants with persistenty elevated acetaminophen concentrations for 2 d, suggesting delayed gastric emptying and/or bezoar formation. A second striking feature of this case was the persistently elevated acetaminophen concentrations without evidence of liver injury despite antidotal therapy not being employed.
Spiller
H A
HA
Kentucky Regional Poison Center, Louisville 40232-5070, USA.
D000082:Acetaminophen / Q000097:blood / Q000506:poisoning*; D001463:Barbiturates / Q000506:poisoning; D011431:Dextropropoxyphene / Q000506:poisoning; D004338:Drug Combinations; D004347:Drug Interactions; D062787:Drug Overdose / Q000628:therapy; D005260:Female; D005746:Gastric Emptying / Q000187:drug effects; D006801:Humans; D006853:Hydrocodone / Q000506:poisoning; D008099:Liver / Q000187:drug effects / Q000473:pathology; D008875:Middle Aged; D009294:Narcotics / Q000506:poisoning; D013997:Time Factors
D001463:Barbiturates; D004338:Drug Combinations; D009294:Narcotics; D000082:Acetaminophen; D006853:Hydrocodone; C004470:butalbital; D011431:Dextropropoxyphene