Citation

Schwartz EA, Hayes BD, Sarmiento KF. Ann. Emerg. Med. 2009; 54(3): 421-423.

Copyright

(Copyright © 2009, American College of Emergency Physicians, Publisher Elsevier Publishing)

DOI

10.1016/j.annemergmed.2008.10.001

PMID

18986731

Abstract

Acetylcysteine is an antidote used to prevent liver failure after acetaminophen overdose. We report the development of liver failure despite administration of intravenous acetylcysteine in a patient with massive ingestion of an acetaminophen and diphenhydramine combination product. An atypical, delayed, bimodal peak in the serum acetaminophen concentration was observed. This case suggests that individualized dosing of antidotal therapy may be needed for preparations of acetaminophen that result in delayed absorption or after massive overdose.

Language: en

Keywords

Acetaminophen; Acetylcysteine; Alanine Transaminase; Analgesics, Non-Narcotic; Antidotes; Aspartate Aminotransferases; Charcoal; Diphenhydramine; Drug Combinations; Drug Overdose; Fatal Outcome; Female; Free Radical Scavengers; Histamine H1 Antagonists; Humans; Liver Failure; Middle Aged; Suicide, Attempted