• Z Koulouris, M G Tierney, and G Jones.
• Department of Pharmacy, Ottawa Hospital, Ontario, Canada.
• Ann Pharmacother. 1999 Nov 1;33(11):1191-4.

ObjectiveTo report a case of metabolic acidosis and coma in a severe acetaminophen overdose.Case SummaryA 29-year-old white woman was admitted to the emergency department with a diminished level of consciousness and metabolic acidosis. The toxicology screen revealed a serum acetaminophen concentration of 1072 microg/mL, and she was consequently treated with intravenous acetylcysteine. Despite the elevated concentration, the patient did not manifest signs of hepatotoxicity.DiscussionMetabolic acidosis and coma are rare manifestations in acetaminophen overdoses. In published case reports, severe acetaminophen ingestion independently causes metabolic acidosis and coma in the absence of hepatotoxicity. The mechanism by which metabolic acidosis occurs is not clearly defined. Studies conducted on animals demonstrated that in severe overdoses, acetaminophen may cause lactic acidosis by inhibiting mitochondrial respiration. The mechanism by which acetaminophen can cause coma is still unknown.ConclusionsSevere acetaminophen overdoses can independently cause metabolic acidosis and coma in the absence of hepatotoxicity.

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