title: [A patient who refused treatment after self-poisoning with paracetamol].
abstract: Two patients, a 20-year-old man and a 33-year-old woman, were admitted with paracetamol poisoning. Both patients refused treatment initially but eventually complied. The man had a paracetamol concentration of 47.5 mg/l 2.5-5.0 h after ingestion, so antidote treatment was not considered necessary. The woman had a paracetamol concentration of 1.37 mg/l 32 h after ingestion and elevated liver enzymes and was treated with N-acetylcysteine intravenously. Both patients recovered. When a patient refuses treatment, the physician must judge whether the patient is capable of making that decision by himself or herself. In the acute setting of attempted suicide, the patient is either incapable of deciding or there is not enough time to make a proper judgement. This means that consent for treatment should be sought from a legal representative of the patient. If this is impossible and treatment is necessary to prevent serious harm, the physician must judge whether the advantages of treatment outweigh the disadvantages of enforced treatment. If this is the case, as in serious paracetamol poisoning, the patient must be treated against their will, even if it requires sedation.
authors.affiliation: Universitair Medisch Centrum St Radboud, 6500 HB Nijmegen. c.kramers@pharmtox.umcn.nl
authors.forename: C
authors.initials: C
authors.lastname: Kramers
authors.forename: F G A
authors.initials: FG
authors.lastname: Jansman
authors.forename: H
authors.initials: H
authors.lastname: Droogleever Fortuyn
mesh_terms: D000082:Acetaminophen / Q000506:poisoning*; D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000506:poisoning*; D062787:Drug Overdose; D005260:Female; D006801:Humans; D008297:Male; D008603:Mental Health; D013406:Suicide, Attempted / Q000523:psychology; D016312:Treatment Refusal / Q000523:psychology*
chemical_list: D018712:Analgesics, Non-Narcotic; D000082:Acetaminophen