Reactions 1476, p26-27 - 2 Nov 2013

O SParacetamol overdose

Early anion gap metabolic acidosis and delayedhaemolytic anaemia: case report

A 40-year-old woman developed early anion gap metabolicacidosis and delayed haemolytic anaemia after an overdose ofparacetamol [acetaminophen].

The woman presented with vomiting and altered mentalstatus following the ingestion of 100 paracetamol 500mgtablets [time to reaction onset not stated]. Sinus tachycardia of123 bpm was noted, and she appeared confused andstuporous. Laboratory tests showed a paracetamolconcentration of 806 µg/mL, a venous pH of 7.26, a lactatelevel of 9.8 mmol/L and an anion gap of 20 mmol/L.

The woman was initiated on acetylcysteine, which wascontinued until her paracetamol concentration decreased to< 10 µg/mL. Over 24 hours, her total bilirubin rose from1.1 mg/dL to 5.5 mg/dL, without increased direct bilirubin.During this time, her haemoglobin level fell from 12.1 g/dL to10.7 g/dL, and her haptoglobin level reached a nadir of7 mg/dL. Her LDH level was elevated at 377 IU/L, and aCoombs test was negative. Her glucose-6-phosphatedehydrogenase level was low, indicating a deficiency. Nofurther complications occurred, and she was subsequentlycleared by psychiatry and discharged home.

Author comment: "We present a case of a female with noprevious history of hemolysis or [glucose-6-phosphate]deficiency, who developed [early anion gap metabolicacidosis] and delayed hemolytic anemia after [paracetamol]overdose".Swoboda H, et al. Lactic acidosis with delayed hemolysis in a massiveacetaminophen overdose. Clinical Toxicology 51: 608-609 abstr. 76, No. 7, Aug2013. Available from: URL: http://dx.doi.org/10.3109/15563650.2013.817658 -USA 803095191

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Reactions 2 Nov 2013 No. 14760114-9954/13/1476-0001/$14.95 Adis © 2013 Springer International Publishing AG. All rights reserved