Development of Hepatic Failure Despite Use of Intravenous Acetylcysteine After a Massive Ingestion of Acetaminophen and Diphenhydramine
Received 11 April 2008; received in revised form 4 June 2008, 6 August 2008 and 18 September 2008; accepted 1 October 2008. published online 05 November 2008.
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.
aDepartment of Medicine, University of Maryland, School of Medicine, Baltimore, MD
bMaryland Poison Centers, University of Maryland School of Pharmacy, Baltimore, MD
Address for correspondence: Kathleen F. Sarmiento, MD, University of Maryland Medical Center, Division of Pulmonary and Critical Care Medicine, 865 West Baltimore St, MSTF 800, Baltimore, MD 21201; 410-706-4771, fax 410-706-0345
Supervising editor: Richard C. Dart, MD, PhD
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Publication date: Available online November 4, 2008.
ABSTRACT