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 ,Revised 18 September 2008 ,Accepted 1 October 2008.

References 

  1. Prescott LF, Illingworth RN, Critchley JA, et al. Intravenous N-acetylcysteine: the treatment of choice for paracetamol poisoning. Br Med J. 1979;2:1097–1100
  2. Prescott LF, Park J, Ballantyne A, et al. Treatment of paracetamol (acetaminophen) poisoning with N-acetylcysteine. Lancet. 1977;2:432–434
  3. Kerr F, Dawson A, Whyte I, et al. The Australasian Clinical Toxicology Investigators Collaboration randomized trial of different loading infusion rates of N-acetylcysteine. Ann Emerg Med. 2005;45:402–408
  4. Buckley NA, Whyte IM, O'Connell DL, et al. Oral or intravenous N-acetylcysteine: which is the treatment of choice for acetaminophen poisoning?. J Toxicol Clin Toxicol. 1999;37:759–767
  5. Bourdeaux C, Bewley J. Death from paracetamol overdose despite appropriate treatment with N-acetylcysteine. Emerg Med J. 2007;24:e31
  6. Ferner RE, Langford NJ, Anton C, et al. Random and systematic medication errors in routine clinical practice: a multicentre study of infusions, using acetylcysteine as an example. Br J Clin Pharmacol. 2001;52:573–577
  7. Tsang WO, Nadroo AM. An unusual case of acetaminophen overdose. Pediatr Emerg Care. 1999;15:344–346
  8. Ho SY, Arellano M, Zolkowski-Wynne J. Delayed increase in acetaminophen concentration after Tylenol PM overdose. Am J Emerg Med. 1999;17:315–317
  9. Halcomb SE, Silvotti ML, Goklaney A, et al. Pharmacokinetic effects of diphenhydramine or oxycodone in simulated acetaminophen overdose. Acad Emerg Med. 2005;12:169–172
  10. Levine BS, Smith ML. Effects of diphenhydramine on immunoassays of phencyclidine in urine. Clin Chem. 1990;36:1258

 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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