Acetaminophen and N-acetylcysteine are removed by hemodialysis

3.5 out of 5 stars Massive acetaminophen overdose: effect of hemodialysis on acetaminophen and acetylcysteine kinetics. Ghannoum M et al. Clin Toxicol 2016 Jul;54:519-22. Abstract As we’ve discussed before, massive acetaminophen [APAP] overdose may be a somewhat different beast from the usual, run-of-the-mill case that reliably responds to N-acetylcysteine [NAC] (if administered at an early stage.)There is evidence that a very large intake of APAP (some say >500 mg/kg) can poison mitochondria, causing severe effects that manifest even before onset of hepatotoxicity. “Massive overdose” is suggested by history of large ingestion in a patient who presents within hours of ingestion, has normal hepatic enzymes and coagulation tests, and is found to have otherwise unexplained metabolic (lactic) acidosis and altered mental status. The Extracorporeal Treatments in Poisoning (ExTRIP) workgroup has suggested that in cases of massive APAP overdose NAC by itself may not be effective even if administered within 8 hours of ingestion, and recommends adding hemodialysis. This case report lends support to that suggestion. This interesting case report describes an 80 kg, 18-yo woman who presented an hour after ingesting 100g APAP. Three hours after ingestion her mental status deteriorated and she was intubated. Laboratory tests showed a lactic acidosis (venous pH 7.19, serum lactate8.6 mmil/L.) There was no laboratory evidence of hepatotoxicity or coagulopathy. Initial...
Source: The Poison Review - Category: Toxicology Authors: Tags: Medical acetaminophen acetylcysteine hemodialysis massive overdose Source Type: news