Massive acetaminophen ingestion with early metabolic acidosis and coma: treatment with IV NAC and continuous venovenous hemodiafiltration

Abstract

The average clearance of acetaminophen by CVVHD was 2.53 L/h, with removal of 24 g of acetaminophen over 16 h. As NAC is effective in preventing hepatic injury after acute acetaminophen overdose, the role of dialysis or CVVHD is limited.

Barakol-induced apoptosis in P19 cells through generation of reactive oxygen species and activation of caspase-9

“…Either the semi-quinone or chromone moiety might further conjugate with GSH, through catalysis by glutathione S-transferase, leading to the depletion of GSH followed by excessive accumulation of ROS. This process might be similar to the generation of a toxic semiquinone metabolite, N-acetyl-p-benzoquinoneimine, responsible for acetaminophen toxicity (Lawanprasert et al, 2001;Wiegand et al, 2010). The involvement of ROS in barakol-induced apoptosis was further confirmed by the finding that NAC, an antidote for acetaminophen toxicity by inhibiting the binding of quinone moiety to the hepatic proteins (Wiegand et al, 2010), could completely inhibit barakol toxicity in P19 cells.…”

L’acidose lactique précoce lors de l’intoxication massive au paracétamol : un trouble métabolique parfois méconnu

“…L'augmentation de la lactatémie ( Il est décrit également que l'acidose contribue fortement à la dégradation de l'état neurologique du patient [11,18] et est responsable en partie de l'hypothermie. Dans la grande majorité des cas, dès l'admission aux urgences médicales, l'état mental du patient est altéré allant de la simple confusion au coma retrouvé chez 2 patients [2,3,10,11,13,14,16]. Avec un score sur l'échelle de Glasgow de 9/15, l'état mental du patient présenté était déjà fortement altéré à l'admission.…”

“Massive Acetaminophen Ingestion with Early Metabolic Acidosis and Coma: Treatment with IV NAC and Continuous Venovenous Hemodiafiltration” by Wiegand et al., Clin Toxicol (Phila) 48:156–159

“…We read the article by Wiegand et al 1 describing a case of massive acetaminophen ingestion treated with intravenous N-acetylcystein and continuous venovenous hemodialfiltration (CVVHDF) with much interest. We believe that CVVHDF holds promise for extracorporal drug elimination after massive overdose, especially in hypotensive patients not eligible for hemodialysis.…”