title: Warning note on a blood gas report leading to diagnosis of acetaminophen overdose.
abstract: OBJECTIVE
  To report a case of acetaminophen toxicity diagnosed after a warning note of "interfering substances" on the blood gas report, leading to early and successful treatment.
  
  
  METHODS
  Case report.
  
  
  METHODS
  Tertiary-care pediatric intensive care unit.
  
  
  METHODS
  A 14-yr-old boy admitted unconscious with lactic academia and hyperglycemia.
  
  
  METHODS
  Routine investigations.
  
  
  RESULTS
  His initial investigations revealed hyperglycemia and lactic acidosis. An annotation of "interfering substances" on the blood gas report prompted us to investigate for toxic substances, and an acetaminophen overdose was confirmed.
  
  
  CONCLUSIONS
  A persistent warning note on the blood gas report of a sick child with elevated lactate and glucose should alert the clinician to the possibility of an acetaminophen overdose.
authors.affiliation: Pediatric Intensive Care Unit, University Hospital, Queens Medical Centre, Nottingham, UK.
authors.forename: Chetan S
authors.initials: CS
authors.lastname: Ashtekar
authors.forename: H
authors.initials: H
authors.lastname: Vyas
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage / Q000097:blood / Q000506:poisoning*; D000111:Acetylcysteine / Q000627:therapeutic use; D000293:Adolescent; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage / Q000097:blood / Q000506:poisoning*; D001786:Blood Glucose / Q000032:analysis; D011431:Dextropropoxyphene / Q000008:administration & dosage / Q000506:poisoning; D004338:Drug Combinations; D062787:Drug Overdose; D015600:Glasgow Coma Scale; D006801:Humans; D015278:Intensive Care Units, Pediatric; D007773:Lactates / Q000097:blood; D008297:Male; D011041:Poisoning / Q000175:diagnosis; D012640:Seizures / Q000139:chemically induced
chemical_list: D018712:Analgesics, Non-Narcotic; D001786:Blood Glucose; D004338:Drug Combinations; D007773:Lactates; D000082:Acetaminophen; D011431:Dextropropoxyphene; D000111:Acetylcysteine