A Massive Acetaminophen Overdose with Unusual Pharmacokinetics
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Keywords
acetaminophen, immediate-release, overdose, pharmacobezoar
Abstract
A clinical case report demonstrates the importance of managing a massive overdose of immediate-release acetaminophen using the same approach reserved for an overdose involving an extended-release formulation because of altered pharmacokinetics.
Résumé
Cet article présente un rapport de cas cliniques démontrant l’importance de traiter une surdose mas-sive d’acétaminophène à libération immédiate en utilisant la même approche que celle utilisée pour traiter une surdose mettant en cause une préparation à libération prolongée en raison de la modification de la pharmacocinétique.
References
2. Athersuch TJ, Antoine DJ, Boobis AR, et al. Paracetamol metabolism, hepatotoxicity, biomarkers and therapeutic interventions: a perspective. Toxicol Res. 2018;7:347–357. http://dx.doi.org/10.1039/c7tx00340d
3. Dart RC, Green JL, Bogdan GM. The safety profile of sustained release paracetamol during therapeutic use and following overdose. Drug Safety. 2005;28:1045–1056. http://dx.doi.org/10.2165/00002018-200528110-00005
4. Prescott LF. Paracetamol overdosage. Drugs. 1983;25:290–314.
http://dx.doi.org/10.2165/00003495-198325030-00002
5. Cairney DG, Beckwith HKS, Al-Hourani K, et al. Plasma paracetamol concentration at hospital presentation has a dose-dependent relationship with liver injury despite prompt treatment with intravenous acetylcysteine. Clin Toxicol. 2016; 54:405–410. http://dx.doi.org/10.3109/15563650.2016.1159309
6. Rumack BH, Peterson RC, Koch GG, et al. Acetaminophen overdose: 662 Cases with evaluation of oral acetylcysteine treatment. Arch Intern Med. 1981;141:380–385. http://dx.doi.org/10.1001/archinte.1981.00340030112020
7. Hendrickson RG, McKeown NJ, West PL, et al. Bactrian (“Double Hump”) acetaminophen pharmacokinetics: a case series and review of the literature. J Med Toxicol. 2010;6:337– 344. http://dx.doi.org/10.1007/s13181-010-0083-9
8. Gussow L. Toxicology rounds: facts and fiction about pharmacobezoars. Emerg Med News. 2020;42. https://journals.lww.com/emnews/Fulltext/2020/09000/Toxicology_Rounds__ Facts_and_Fiction_about.16.aspx.
9. Smith SW, Howland MA, Hoffman RS, et al. acetaminophen overdose with altered acetaminophen pharmacokinetics and hepatotoxicity associated with premature cessation of intravenous n-acetylcysteine therapy. Ann Pharmacother. 2008;42:1333–1339. http://dx.doi.org/10.1345/aph.1K680
10. Ontario Poison Centre. Recommended Investigations for Acetaminophen-Overdose Patients. Ontario Poison Centre; 2019. https://www.ontariopoisoncentre.ca/siteassets/pdfs/ english/78800-recommended-investigations2.pdf.
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Articles are published under a Creative Commons Attribution - Non Commercial 4.0 International License. Authors and users are free to copy and redistribute the material in any medium or format, with proper attribution, for non-commercial purposes. Authors retain copyright to their article.
Benjamin Katzman, McMaster University, Hamilton, Canada
Michael DeGroote School of Medicine, McMaster University, Hamilton, Canada
Mitchell Levine, McMaster University, Hamilton, Canada
Department of Health Research Methods, Evidence & Impact, and Department of Medicine, Division of Clinical Pharmacology and Toxicology, McMaster University, Hamilton, Canada