Massive Acetaminophen Overdose Treated Successfully with N-Acetylcysteine, Fomepizole, and Hemodialysis
Acetaminophen overdose is one of the most common causes of acute hepatic failure in the developed world. There is strong evidence for N-acetylcysteine (NAC) as a safe and effective antidote for acetaminophen toxicity. However, there is less clarity in the management of massive overdoses (acute, sing...
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| Format: | Article |
| Language: | English |
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Wiley
2021-01-01
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| Series: | Case Reports in Critical Care |
| Online Access: | http://dx.doi.org/10.1155/2021/6695967 |
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| author | Michael H. Chiu Natalia Jaworska Nicholas L. Li Mark Yarema |
| author_facet | Michael H. Chiu Natalia Jaworska Nicholas L. Li Mark Yarema |
| author_sort | Michael H. Chiu |
| collection | DOAJ |
| description | Acetaminophen overdose is one of the most common causes of acute hepatic failure in the developed world. There is strong evidence for N-acetylcysteine (NAC) as a safe and effective antidote for acetaminophen toxicity. However, there is less clarity in the management of massive overdoses (acute, single ingestions>500 mg/kg with 4-hour equivalent concentrations ~6000 μmol/L) which are often associated with metabolic acidosis and multiorgan dysfunction. In such ingestions, the role of adjuvant treatments such as fomepizole and extracorporeal removal is unclear. We present a case of a 20-year-old female presenting with an acute ingestion of over 120 grams (1764.7 mg/kg) and an acetaminophen concentration of 5880 μmol/L who developed refractory shock, decreased level of consciousness, and metabolic acidosis requiring mechanical ventilation and vasopressor support. She was treated with gastric decontamination with activated charcoal, IV NAC, fomepizole, and hemodialysis. The patient had complete clearance of acetaminophen by 32 hours after presentation and normalization of her acid base and hemodynamic status without any organ failure. This case highlights the potential benefit of a triple strategy of NAC, fomepizole, and early hemodialysis in massive acetaminophen overdose, potentially sparing complications of prolonged intubation and ICU hospitalization. |
| format | Article |
| id | doaj-art-c4570fac03b846cb9f87072f511398d9 |
| institution | Kabale University |
| issn | 2090-6420 2090-6439 |
| language | English |
| publishDate | 2021-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Critical Care |
| spelling | doaj-art-c4570fac03b846cb9f87072f511398d92025-02-03T01:26:59ZengWileyCase Reports in Critical Care2090-64202090-64392021-01-01202110.1155/2021/66959676695967Massive Acetaminophen Overdose Treated Successfully with N-Acetylcysteine, Fomepizole, and HemodialysisMichael H. Chiu0Natalia Jaworska1Nicholas L. Li2Mark Yarema3Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, AB, CanadaDepartment of Critical Care Medicine, Cumming School of Medicine, University of Calgary, AB, CanadaDepartment of Medicine, Division of Nephrology, Cumming School of Medicine, University of Calgary, AB, CanadaDepartment of Critical Care Medicine, Cumming School of Medicine, University of Calgary, AB, CanadaAcetaminophen overdose is one of the most common causes of acute hepatic failure in the developed world. There is strong evidence for N-acetylcysteine (NAC) as a safe and effective antidote for acetaminophen toxicity. However, there is less clarity in the management of massive overdoses (acute, single ingestions>500 mg/kg with 4-hour equivalent concentrations ~6000 μmol/L) which are often associated with metabolic acidosis and multiorgan dysfunction. In such ingestions, the role of adjuvant treatments such as fomepizole and extracorporeal removal is unclear. We present a case of a 20-year-old female presenting with an acute ingestion of over 120 grams (1764.7 mg/kg) and an acetaminophen concentration of 5880 μmol/L who developed refractory shock, decreased level of consciousness, and metabolic acidosis requiring mechanical ventilation and vasopressor support. She was treated with gastric decontamination with activated charcoal, IV NAC, fomepizole, and hemodialysis. The patient had complete clearance of acetaminophen by 32 hours after presentation and normalization of her acid base and hemodynamic status without any organ failure. This case highlights the potential benefit of a triple strategy of NAC, fomepizole, and early hemodialysis in massive acetaminophen overdose, potentially sparing complications of prolonged intubation and ICU hospitalization.http://dx.doi.org/10.1155/2021/6695967 |
| spellingShingle | Michael H. Chiu Natalia Jaworska Nicholas L. Li Mark Yarema Massive Acetaminophen Overdose Treated Successfully with N-Acetylcysteine, Fomepizole, and Hemodialysis Case Reports in Critical Care |
| title | Massive Acetaminophen Overdose Treated Successfully with N-Acetylcysteine, Fomepizole, and Hemodialysis |
| title_full | Massive Acetaminophen Overdose Treated Successfully with N-Acetylcysteine, Fomepizole, and Hemodialysis |
| title_fullStr | Massive Acetaminophen Overdose Treated Successfully with N-Acetylcysteine, Fomepizole, and Hemodialysis |
| title_full_unstemmed | Massive Acetaminophen Overdose Treated Successfully with N-Acetylcysteine, Fomepizole, and Hemodialysis |
| title_short | Massive Acetaminophen Overdose Treated Successfully with N-Acetylcysteine, Fomepizole, and Hemodialysis |
| title_sort | massive acetaminophen overdose treated successfully with n acetylcysteine fomepizole and hemodialysis |
| url | http://dx.doi.org/10.1155/2021/6695967 |
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