Abstract

Particularly large acetaminophen overdoses, termed massive, create a therapeutic challenge given the standardized, N-acetylcysteine-based treatment. One consideration in addition to N-acetylcysteine is the initiation of hemodialysis due to the dialyzable nature of acetaminophen, though encumbered by the concurrent removal of the antidote, N-acetylcysteine. Such cases of large acetaminophen overdose, along with possible concomitant ingestions of other drugs or inactive ingredients, can be complicated by challenging-to-interpret clinical signs and laboratory findings. We describe a case of a 46-year-old man for whom we were consulted regarding consideration of dialysis treatment 7 hours after ingestion of 125 g of acetaminophen. The patient developed multiple early signs and laboratory findings consistent with a significant acetaminophen overdose. He also developed a rarely described, likely acetaminophen-interference-induced laboratory abnormality. Finally, he possibly had toxicity from an “inactive” ingredient. He was treated with a single session of prolonged hemodialysis (9.5 hours) and increased dosing of N-acetylcysteine with a positive outcome. Herein, we discuss the decision making and interpretation of clinical data pertaining to dialysis treatment and other therapies after a massive acetaminophen overdose.

Author Details

Authors

• Daniel Murphy¹
• Abrar Khan¹
• Christine Borscheid²
• Samy Riad¹

Departments

• ¹ Department of Medicine and
• ² M Health Fairview, University of Minnesota, Minneapolis, MN, USA

Address

Samy Riad, MD, MS, Assistant Professor of Medicine, Division of Renal Diseases and Hypertension, Department of Medicine, University of Minnesota, 717 Delaware Street SE, Mail Code 1932, Minneapolis, MN 55414, USA
Email: [email protected]

Log in for Subscribers

Citation