title: Delayed and prolonged elevated serum paracetamol level after an overdose - possible causes and implications.
abstract: We report the case of a 29-year-old man who ingested about 50 g of standard-preparation paracetamol plus other medications. The serum paracetamol level remained low in the first 24 hours. It peaked 54 hours after ingestion and remained high for 5 days. An N-acetylcysteine (NAC) infusion was started at admission, but was ceased 36 hours later as the clinical and laboratory signs were reassuring. On Day 3, the patient's liver function deteriorated and a rising serum paracetamol level was noted; hence, an NAC infusion was reinitiated. Despite this, the patient developed fulminant hepatic failure. This case underlines the importance of monitoring paracetamol levels and liver function for at least 72 hours after a suspected large overdose of paracetamol before discontinuing NAC infusion.
authors: Intensive Care Unit, Flinders Medical Centre, Adelaide, SA, Australia. biharishailesh@gmail.com
authors: Shailesh
authors: S
authors: Bihari
authors: Santosh
authors: S
authors: Verghese
authors: Andrew D
authors: AD
authors: Bersten
mesh_terms: D000082:Acetaminophen / Q000097:blood* / Q000506:poisoning*; D000111:Acetylcysteine / Q000008:administration & dosage*; D000328:Adult; D062787:Drug Overdose; D006801:Humans; D008111:Liver Function Tests; D008297:Male; D049451:Nomograms; D013997:Time Factors
chemical_list: D000082:Acetaminophen; D000111:Acetylcysteine