Death from paracetamol overdose despite appropriate treatment with N-acetylcysteine.
A case of death from severe paracetamol poisoning which presented early and received appropriate treatment according to evidence-based guidelines is presented here. It is very rare for patients to die from paracetamol poisoning when they receive N-acetylcysteine (NAC) within 8 h of ingestion. The patient had a marked lactic acidosis on presentation to hospital. This case demonstrates that a patient can die from paracetamol poisoning despite early and appropriate treatment, and raises the question whether lactic acidosis in a patient following paracetamol overdose should prompt the initiation of NAC treatment while awaiting paracetamol levels.
Bourdeaux
Chris
C
Department of Anaesthesia, Bristol Royal Infirmary, Bristol, UK. chrisbourdeaux@googlemail.com
Bewley
Jeremy
J
D000082:Acetaminophen / Q000506:poisoning*; D000111:Acetylcysteine / Q000627:therapeutic use*; D018712:Analgesics, Non-Narcotic / Q000506:poisoning*; D062787:Drug Overdose / Q000150:complications / Q000188:drug therapy; D017809:Fatal Outcome; D016166:Free Radical Scavengers / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000139:chemically induced
D018712:Analgesics, Non-Narcotic; D016166:Free Radical Scavengers; D000082:Acetaminophen; D000111:Acetylcysteine