Acetaminophen is an analgesic drug that is frequently used in suicide attempts. In this paper, we report on a 17-year-old girl who was admitted to an emergency department 15 hours after taking acetaminophen pills in a suicide attempt. Her serum acetaminophen level was 73 mg/L on admission; she had elevated liver enzymes suggesting hepatic necrosis. She was started on N-acetyl cystein (NAC), and treated successfully with a fractionated plasma separation and absorption system.
Roberts LJ, II, Morrow JDAnalgesic-antipyretic and antiinflammatory agents and drugs. In: Hardman JG, Limbird LE, Gilman AG (eds.) The pharmacological basis of therapeutics. New York: McGraw-Hill, 2001, p.703.
2.
Singer PP, Jones GR, Bannach BG, Denmark L.Acute fatal acetaminophen overdose without liver necrosis. J Forensic Sci2007; 52: 992-994.
3.
Bourdeaux C. , Bewley J.Death from acetaminophen overdose despite appropriate treatment with N-acetylcysteine. Emerg Med J2007; 24: 31-33.
4.
Prescott LF, Highley MSDrugs prescribed for self poisoners. Br Med J (Clin Res Ed)1985; 290: 1633-1636.
5.
Larson AM, Polson J., Fontana RJ, et al. Acetaminophen-induced acute liver failure: results of a United States multicenter, prospective study. Hepatology2005; 42: 1364-1372.
6.
Lee WMAcetaminophen and the U.S. Acute Liver Failure Study Group: lowering the risks of hepatic failure. Hepatology2004; 40: 6-9.
Rumack BHAcetaminophen overdose in young children: treatment and effects of alcohol and additional ingestants in 416 cases. Am J Dis Child1984; 138: 428-433.
9.
Davies A.Acetaminophen and liver function. N Eng J Med1994; 331: 1907-1908.
10.
Ellenhorm MJ, Schonwald S , Ordog G, Wasserberger J (eds.). Ellernhorn’s medical toxicology: diagnosis and treatment of human poisoning. 2nd ed. Baltimore: Williams and Wilkins, 1997, p.180-195.
11.
Prescott LF, Illingworth RN, Critchley JA, Proudfoot ATIntravenous N-acetylcysteine: the treatment of choice for paracetamol poisoning . BMJ1979; 2: 1097-1100.
12.
Smilkstein MJ , Knapp GL, Kulig KW, Rumack BHEfficacy of oral N-acetylcysteine in the treatment of acetaminophen overdose. Analysis of the national multicenter study (1976 to 1985). N Engl J Med1988; 319:1557-1562.
13.
Falkenhagen D., Strobl W., Vogt G., et al. Fractionated plasma separation and adsorption system: a novel system for blood purification to remove albumin bound substances. Artif Organs1999; 23: 81-86.
14.
Rifai, K., Ernst T., Kretschmer U., et al. Prometheus - a new extracorporeal system for the treatment of liver failureJ Hepatol2003; 39: 984-990.
15.
Mitzner S., Stange J., Klammt S., Peszynski P., Schmidt R., Nöldge-Schomburg G.Extracorporeal detoxification using the molecular adsorbent recirculating system for critically ill patients with liver failure. J Am Soc Nephrol2001; 12: S75-S82.
16.
Mitzner S., Klammt S., Stange J., Schmidt R.Albumin regeneration in liver support-comparison of different methods. Ther Apher Dial2006; 10: 108-117.
17.
Damsten MC, Commandeur JN, Fidder A., et al. Liquid chromatography/tandem mass spectrometry detection of covalent binding of acetaminophen to human serum albumin. Drug Metab Dispos2007; 35: 1408-1417.
18.
Koivusalo AM , Yildirim Y., Vakkuri A., Lindgren L., Höckerstedt K., Isoniemi H.Experience with albumin dialysis in five patients with severe overdoses of acetaminophen. Acta Anaesthesiol Scand2003; 47: 1145-1150.
19.
Bakos A., Rikker C., Tóvárosi S., Kárteszi M.Therapeutic effect of the latest extracorporal elimination procedure (Prometheus treatment) in acute liver failure caused by intoxication. Orv Hetil2007; 148: 1981- 1988 [in Hungarian].
20.
Skwarek A., Grodzicki M., Nyckowski P., et al. The use Prometheus FPSA system in the treatment of acute liver failure: preliminary results. Transplant Proc2006; 38: 209-211.