Often an overdose of acetaminophen is unintentional, as it is a common ingredient in many over-the-counter painkillers. Last updated on Jan 20, 2023.Īcetadote is an FDA approved injection used to treat acetaminophen overdose.Īcetadote (acetylcysteine) is used in an emergency room setting to prevent or lessen potential liver damage resulting from an overdose of acetaminophen. This case highlights the need for further investigation in the management of massive APAP overdose, including optimal method and timing of renal replacement therapy.Medically reviewed by Melisa Puckey, BPharm. This is the first description of a fatal acetaminophen ingestion refractory to both IHD and prolonged CRRT. Despite these interventions, fulminant liver failure progressed with cerebral edema, coagulopathy and death.
We describe a case of massive APAP overdose presenting with altered mental status and lactic acidosis, refractory to multiple treatments of IHD as well as CRRT and high-dose NAC along with fomepizole. One treatment with IHD is typically sufficient for resolution of acidosis and global improvement clinically. While N-acetylcysteine (NAC) remains the cornerstone of treatment for APAP overdose, extracorporeal treatment, in the form of renal replacement therapy with intermittent hemodialysis (IHD) or continuous renal replacement therapy (CRRT) may provide benefit in cases associated with altered mental status and metabolic acidosis. Massive Acetaminophen ( N-acetyl-p-aminophenol APAP) overdose is a common presentation to emergency departments around the world.
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