Potentially fatal paracetamol overdose and successful treatment with 3 days of intravenous N-acetylcysteine regime--a case report. Annals of the Academy of Medicine, Singapore [Ann Acad Med Singapore] Journal article

Title	Potentially fatal paracetamol overdose and successful treatment with 3 days of intravenous N-acetylcysteine regime--a case report.
Author(s)	Sule AA, Tai DY, Tze CC, Deepa B, Leow MK, Leow M
Institution	Department of General Medicine, Tan Tock Seng Hospital, Singapore.
Source	Ann Acad Med Singapore 2006 Feb; 35(2):108-11.
MeSH	Acetaminophen Acetylcysteine Adult Amylases Antidotes Codeine Female Humans Liver Function Tests Narcotics Overdose Suicide, Attempted Tablets Time Factors
Abstract	INTRODUCTION: Paracetamol overdose is the most common drug overdose worldwide. To our knowledge, the maximum number of paracetamol tablets ingested reported in the literature is 45 g. CLINICAL PICTURE: We describe a 21-year-old patient who acutely ingested 120 tablets, each 500 mg paracetamol (i.e., 60 g equivalent to 1200 mg/kg body weight) in a suicidal attempt. Our patient also drank 2 bottles of codeine-based cough syrup equivalent to 360 mg of codeine. At 6 hours post ingestion, her serum paracetamol level was 207 mg/L. The poor prognostic factors for paracetamol overdose in our patient included massive paracetamol ingestion (confirmed by blood levels), codeine co-ingestion and elevated serum amylase (189 U/L). TREATMENT: She was treated with a 3-day modified regimen of intravenous N-acetylcysteine. OUTCOME: The liver function tests and the prothrombin time remained normal over the second and third day of admission and the patient was discharged without complications on the fifth day. CONCLUSION: From this experience we feel that in very severe paracetamol poisoning, a modified regime of intravenous N- acetylcysteine for 3 days is safe and efficacious.
Language	eng
Pub Type(s)	Case Reports Journal Article
PubMed ID	16565765

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