Early metabolic acidosis and coma in massive acetaminophen overdose

3.5 out of 5 stars Coma and Severe Acidosis: Remember to Consider Acetaminophen. Villano JH et al. J Med Toxicol 2015 July 8 [Epub ahead of print] Reference This paper, from UC-San Diego, contains an excellent case discussion that makes numerous important points about a patient who presents with decreased mental status and high-anion-gap metabolic acidosis. The patient was a 28-year-old male who was brought to the emergency department because he was found to be unresponsive in his jail cell 16 hours after being arrested for murder. Initial evaluation revealed tachycardia (111/min,) mild hypothermia (95.5oF,) and a depressed level of consciousness with non-focal neurological examination. Blood glucose was 362 mg/dL. Tests results included arterial pH 6.97, pCO2 40 mmHg, serum bicarbonate 7 mEq/L, anion gap 34 mEq/L. Aspartate aminotransferase (AST) and prothrombin time (PT) were minimally elevated but ALT and bilirubin levels were normal, as was the head CT. Serum salicylate was negative. The serum lactate was 156.5 mg/dL (normal 4.5 – 19.8 mg/dL.) The authors discuss at length the initial diagnostic considerations — methanol, ethylene glycol, metformin, cyanide — and the evidence for or against each one. Although acetaminophen (APAP) poisoning does not seem to have been on the initial differential diagnosis of high-anion-gap metabolic acidosis with an elevated lactate level, a routine serum APAP was 616 mcg/mL. (This was drawn at least 16 hours post-ingestion.) The ...
Source: The Poison Review - Category: Toxicology Authors: Tags: Medical acetaminophen overdose APAP elevated anion gap metabolic acidosis Source Type: news