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Case Reports
Delayed and prolonged elevated serum paracetamol level after an overdose - possible causes and implications.
- Shailesh Bihari and Santosh Verghese.
- Intensive Care Unit, Flinders Medical Centre, Adelaide, SA, Australia. biharishailesh@gmail.com
- Crit Care Resusc. 2011 Dec 1;13(4):275-7.
AbstractWe report the case of a 29-year-old man who ingested about 50 g of standard-preparation paracetamol plus other medications. The serum paracetamol level remained low in the first 24 hours. It peaked 54 hours after ingestion and remained high for 5 days. An N-acetylcysteine (NAC) infusion was started at admission, but was ceased 36 hours later as the clinical and laboratory signs were reassuring. On Day 3, the patient's liver function deteriorated and a rising serum paracetamol level was noted; hence, an NAC infusion was reinitiated. Despite this, the patient developed fulminant hepatic failure. This case underlines the importance of monitoring paracetamol levels and liver function for at least 72 hours after a suspected large overdose of paracetamol before discontinuing NAC infusion.
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