title: Double-peaked Acetaminophen Concentration Secondary to Intestinal Trauma.
abstract: BackgroundReduced gastrointestinal motility can alter the toxicokinetics of acetaminophen poisoning. We report a case of altered acetaminophen toxicokinetics due to delayed gastrointestinal absorption, likely secondary to intestinal trauma/surgery.  Case ReportA 37-year-old woman ingested an unknown amount of acetaminophen and ethanol then stabbed herself in the abdomen. The initial acetaminophen was 1,285.9 μmol/L and the time of ingestion was not known. Intravenous acetylcysteine protocol was started. She developed an ileus post-surgery for the stab wounds. At 31 hours post-presentation, the acetaminophen returned undetectable, and the transaminases were normal. After the resolution of the ileus, repeated acetaminophen peaked at 363.3 μmol/L 52 hours post-admission. At 76 hours post-admission, the acetaminophen was undetectable, and transaminases and coagulation parameters were normal. ConclusionsReduction in gastrointestinal motility secondary to trauma and/or surgery must be considered when determining when to initiate or discontinue treatment as well as how long to monitor acetaminophen concentrations.
authors.forename: B
authors.initials: B
authors.lastname: Alyahya
authors.forename: S
authors.initials: S
authors.lastname: Tamur
authors.forename: S
authors.initials: S
authors.lastname: Aljenedil
authors.forename: A
authors.initials: A
authors.lastname: Larocuque
authors.forename: E
authors.initials: E
authors.lastname: Holody
authors.forename: S
authors.initials: S
authors.lastname: Gosselin
mesh_terms: D000082:Acetaminophen / Q000493:pharmacokinetics* / Q000506:poisoning; D000111:Acetylcysteine / Q000008:administration & dosage; D000328:Adult; D000431:Ethanol / Q000506:poisoning; D005260:Female; D006801:Humans; D007422:Intestines / Q000293:injuries*; D056950:Period Circadian Proteins / Q000008:administration & dosage; D014951:Wounds, Stab / Q000503:physiopathology*; D029867:Xenopus Proteins / Q000008:administration & dosage
chemical_list: C539025:Per1 protein, Xenopus; D056950:Period Circadian Proteins; D029867:Xenopus Proteins; D000082:Acetaminophen; D000431:Ethanol; D000111:Acetylcysteine