Annals of Emergency Medicine
Volume 54, Issue 3 , Pages 421-423, September 2009

Development of Hepatic Failure Despite Use of Intravenous Acetylcysteine After a Massive Ingestion of Acetaminophen and Diphenhydramine

  • Eric A. Schwartz, MD

      Affiliations

    • Department of Medicine, University of Maryland, School of Medicine, Baltimore, MD
    • ,
  • Bryan D. Hayes, PharmD

      Affiliations

    • Maryland Poison Centers, University of Maryland School of Pharmacy, Baltimore, MD
    • ,
  • Kathleen F. Sarmiento, MD

      Affiliations

    • Department of Medicine, University of Maryland, School of Medicine, Baltimore, MD
    • Corresponding Author InformationAddress 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

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.

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 Supervising editor: Richard C. Dart, MD, PhD

 Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. The authors have stated that no such relationships exist. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement.

 Publication date: Available online November 4, 2008.

 Reprints not available from the authors.

PII: S0196-0644(08)01853-2

doi:10.1016/j.annemergmed.2008.10.001

Annals of Emergency Medicine
Volume 54, Issue 3 , Pages 421-423, September 2009

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