Hypokalaemia following paracetamol overdose in two teenage girls.
We report on two teenage girls presenting following significant paracetamol overdoses (>28 g paracetamol). Both presented within 4 h of the overdose and both were treated with N-acetylcysteine, in accordance with the National Poisons Information Service protocol. Within 8 h of presentation both had developed significant hypokalaemia with serum potassium concentrations <3.0 mmol/L and were treated with intravenous potassium chloride. Potassium concentrations returned to within reference limits (>3.5 mmol/L) after commencing potassium chloride supplementation. An audit of potassium concentrations in 254 patients presenting with significant paracetamol overdose (paracetamol >0.5 mmol/L) admitted through four A&E departments in the West of Scotland showed a significant decline in mean serum potassium from 3.9 mmol/L on admission to 3.6 mmol/L (P = <0.001) over the next 36 h. The mechanism for this hypokalaemia in these two individuals is unclear, however regular monitoring of potassium is advocated in such patients during their initial treatment.
Godber
Ian M
IM
Biochemistry Department, Wishaw General Hospital, Wishaw, Lanarkshire, UK. ian.godber@lanarkshire.scot.nhs.uk
Jarvis
Sarah J
SJ
Maguire
Donogh
D
D000082:Acetaminophen / Q000097:blood / Q000506:poisoning*; D000111:Acetylcysteine / Q000627:therapeutic use; D000293:Adolescent; D018712:Analgesics, Non-Narcotic / Q000097:blood / Q000506:poisoning*; D062787:Drug Overdose; D005260:Female; D006801:Humans; D007008:Hypokalemia / Q000139:chemically induced* / Q000188:drug therapy / Q000378:metabolism; D008099:Liver / Q000187:drug effects / Q000378:metabolism; D013406:Suicide, Attempted
D018712:Analgesics, Non-Narcotic; D000082:Acetaminophen; D000111:Acetylcysteine