PMID- 20199132
OWN - NLM
STAT- MEDLINE
DCOM- 20100325
LR  - 20131121
IS  - 1556-9519 (Electronic)
IS  - 1556-3650 (Linking)
VI  - 48
IP  - 2
DP  - 2010 Feb
TI  - Massive acetaminophen ingestion with early metabolic acidosis and coma: treatment 
      with IV NAC and continuous venovenous hemodiafiltration.
PG  - 156-9
LID - 10.3109/15563650903524142 [doi]
AB  - CONTEXT: We report the extraction of acetaminophen by continuous venovenous 
      hemodiafiltration (CVVHD) during treatment of an acute ingestion of 200 g with a 
      peak recorded serum acetaminophen level of 1,614 mg/L (10,652 micromol/L). CASE 
      DETAILS: The patient presented with early onset of coma, metabolic acidosis, and 
      hypotension in the absence of significant hepatic injury. In addition to 
      N-acetylcysteine (NAC) therapy, CVVHD was performed to manage the acid-base 
      disturbance. Flow rate, effluent volume, and serum and effluent drug 
      concentrations were obtained at hourly intervals. During 16 h of CVVHD the 
      acetaminophen level dropped from 1,212 to 247 mg/L. DISCUSSION: 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.
FAU - Wiegand, Timothy J
AU  - Wiegand TJ
AD  - Department of Medicine and Emergency Medicine, Maine Medical Center and Northern 
      New England Poison Center, 901 Washington Avenue, Portland, ME 04102, USA. 
      wiegat@mmc.org
FAU - Margaretten, Mary
AU  - Margaretten M
FAU - Olson, Kent R
AU  - Olson KR
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - England
TA  - Clin Toxicol (Phila)
JT  - Clinical toxicology (Philadelphia, Pa.)
JID - 101241654
RN  - 0 (Analgesics, Non-Narcotic)
RN  - 0 (Antidotes)
RN  - 362O9ITL9D (Acetaminophen)
RN  - WYQ7N0BPYC (Acetylcysteine)
SB  - IM
CIN - Clin Toxicol (Phila). 2010 Nov;48(9):961; author reply 961-2. PMID: 21171858
MH  - Acetaminophen/blood/*poisoning
MH  - Acetylcysteine/*therapeutic use
MH  - Acidosis/chemically induced
MH  - Analgesics, Non-Narcotic/blood/*poisoning
MH  - Antidotes/therapeutic use
MH  - Coma/chemically induced
MH  - Combined Modality Therapy
MH  - Drug Overdose
MH  - Female
MH  - Hemodiafiltration/*methods
MH  - Humans
MH  - Hypotension/chemically induced
MH  - Young Adult
EDAT- 2010/03/05 06:00
MHDA- 2010/03/26 06:00
CRDT- 2010/03/05 06:00
PHST- 2010/03/05 06:00 [entrez]
PHST- 2010/03/05 06:00 [pubmed]
PHST- 2010/03/26 06:00 [medline]
AID - 10.3109/15563650903524142 [doi]
PST - ppublish
SO  - Clin Toxicol (Phila). 2010 Feb;48(2):156-9. doi: 10.3109/15563650903524142.