title: Development of hepatic failure despite use of intravenous acetylcysteine after a massive ingestion of acetaminophen and diphenhydramine.
abstract: Acetylcysteine is an antidote used to prevent liver failure after acetaminophen overdose. We report the development of liver failure despite administration of intravenous acetylcysteine in a patient with massive ingestion of an acetaminophen and diphenhydramine combination product. An atypical, delayed, bimodal peak in the serum acetaminophen concentration was observed. This case suggests that individualized dosing of antidotal therapy may be needed for preparations of acetaminophen that result in delayed absorption or after massive overdose.
authors.affiliation: Department of Medicine, University of Maryland, School of Medicine, Baltimore, MD, USA.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Schwartz
authors.forename: Bryan D
authors.initials: BD
authors.lastname: Hayes
authors.forename: Kathleen F
authors.initials: KF
authors.lastname: Sarmiento
mesh_terms: D000082:Acetaminophen / Q000097:blood / Q000506:poisoning*; D000111:Acetylcysteine / Q000008:administration & dosage*; D000410:Alanine Transaminase / Q000097:blood; D018712:Analgesics, Non-Narcotic / Q000097:blood / Q000506:poisoning*; D000931:Antidotes / Q000008:administration & dosage; D001219:Aspartate Aminotransferases / Q000097:blood; D002606:Charcoal / Q000008:administration & dosage; D004155:Diphenhydramine / Q000506:poisoning*; D004338:Drug Combinations; D062787:Drug Overdose / Q000097:blood / Q000188:drug therapy; D017809:Fatal Outcome; D005260:Female; D016166:Free Radical Scavengers / Q000008:administration & dosage*; D006634:Histamine H1 Antagonists / Q000506:poisoning*; D006801:Humans; D017093:Liver Failure / Q000139:chemically induced; D008875:Middle Aged; D013406:Suicide, Attempted
chemical_list: D018712:Analgesics, Non-Narcotic; D000931:Antidotes; D004338:Drug Combinations; D016166:Free Radical Scavengers; D006634:Histamine H1 Antagonists; D002606:Charcoal; D000082:Acetaminophen; D004155:Diphenhydramine; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D000111:Acetylcysteine