Reactions 1454 - 1 Jun 2013

SParacetamol

Encephalopathy, hyperbilirubinaemia,coagulopathy: case report

A 37-year-old woman developed encephalopathy,hyperbilirubinaemia and coagulopathy associated withparacetamol [acetaminophen] toxicity.

The woman presented with encephalopathy,hyperbilirubinaemia and coagulopathy, and was found to havea toxic paracetamol concentration 48 hours after ingestion[dosage and indication not stated]. Her neurological statusdeteriorated and she showed signs of impending centralherniation, including bilateral Babinski sign, sustained clonusand extensor posturing.

The woman was treated in an ICU; hypernatraemia andhypothermia were induced. Her INR was significantly elevatedand her liver function tests were deteriorating; she receivedcontinuous renal replacement therapy in order to maintainhypernatraemia. She was cooled for 6 days and subsequentlyunderwent rewarming when her neurological status and liverfunction improved. She was extubated and on hospital day 32she was discharged; she had made a complete neurologicrecovery and her liver function was improving.

Author comment: "A 37-year-old female with a pastmedical history significant for alcohol dependence presentedwith encephalopathy, coagulopathy and hyperbilirubinaemiaand was found to have a toxic acetaminophen level 48 hoursafter ingestion."Roske J, et al. Severe encephalopathy and impending cerebral herniation inacetaminophen toxicity: Recovery with a novel hypernatremic/hypothermicprotocol. Critical Care Medicine 39: 19, Dec 2011. Available from: URL: http://dx.doi.org/10.1097/01.ccm.0000408627.24229.88 [abstract] - USA 803087618

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Reactions 1 Jun 2013 No. 14540114-9954/10/1454-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved