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.
MeSH terms
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Acetaminophen / blood
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Acetaminophen / poisoning*
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Acetylcysteine / administration & dosage*
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Alanine Transaminase / blood
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Analgesics, Non-Narcotic / blood
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Analgesics, Non-Narcotic / poisoning*
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Antidotes / administration & dosage
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Aspartate Aminotransferases / blood
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Charcoal / administration & dosage
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Diphenhydramine / poisoning*
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Drug Combinations
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Drug Overdose / blood
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Drug Overdose / drug therapy
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Fatal Outcome
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Female
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Free Radical Scavengers / administration & dosage*
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Histamine H1 Antagonists / poisoning*
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Humans
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Liver Failure / chemically induced
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Middle Aged
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Suicide, Attempted
Substances
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Analgesics, Non-Narcotic
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Antidotes
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Drug Combinations
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Free Radical Scavengers
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Histamine H1 Antagonists
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Charcoal
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Acetaminophen
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Diphenhydramine
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Aspartate Aminotransferases
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Alanine Transaminase
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Acetylcysteine