n-monoacetylcystine and Drug-Overdose

Here, we review the case of a 26 1/7 weeks' gestation premature female infant born to a mother who intentionally ingested a large quantity of Tylenol, aspirin, quetiapine, and prenatal vitamins. The neonate subsequently had markedly elevated levels of both Tylenol and aspirin when checked on the first day of life. While overall clinically stable, the neonate did demonstrate coagulopathy as evidenced by abnormal coagulation studies. Both poison control and a pediatric gastroenterologist/hepatologist were consulted. She successfully tolerated a course of N-acetylcysteine; her subsequent Tylenol level was markedly decreased and the neonate exhibited no further effects of toxicity. The salicylate level decreased on its own accord. To our knowledge, this is the first report of a neonate at 26 weeks' gestation that has been successfully managed for supratherapeutic concentrations of acetaminophen and acetylsalicylic acid secondary to maternal ingestion. While rare, this case may serve as a reference for the effectiveness of N-acetylcysteine in premature infants in such instances.

Topics: Acetaminophen; Antidepressive Agents; Antidotes; Aspirin; Cystine; Drug Overdose; Female; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Maternal Exposure; Poisoning; Pregnancy; Quetiapine Fumarate; Sodium Bicarbonate; Suicide, Attempted

Acetaminophen (APAP) toxicity is the most common cause of acute liver failure in the US and Europe. Massive hepatocyte necrosis is the predominant feature of APAP-induced acute liver injury (ALI). Liver regeneration is a vital process for survival after a toxic insult, it occurs at a relative late time point after the injurious phase. Currently, N-acetylcysteine (NAC), a glutathione precursor, is the antidote for acetaminophen overdose. However, NAC is effective only for patients who present within hours of an acute overdose, and is less effective for late-presenting patients. It is possible that in delayed patients, previously reduced endogenous glutathione (GSH) level has restored and prolonged treatment with NAC might be toxic and impair liver regeneration. Therefore, we hypothesize that prolonged treatment with NAC impairs liver regeneration in ALI induced by APAP.. ALI was induced in C57BL/6 male mice by a single dose of APAP (350 mg/kg) by intraperitoneal injection. After two hours of APAP challenge, the mice were given 100 mg/kg NAC dissolved in 0.6 mL saline, or saline treatment every 12 hours for a total of 72 hours.. Seventy-two hours after APAP challenge, compared with saline treatment, NAC treatment significantly increased serum transaminases (alanine transaminase/aspartate aminotransferase), induced evident hepatocyte vacuolation in the periportal area and delayed liver regeneration seen in histopathology. This detrimental effect was associated with reduced hepatic nuclear factor (NF)-kappaB DNA binding and decreased expression of cell cycle protein cyclin D1, two important factors in liver regeneration.. Prolonged treatment with NAC impairs liver regeneration in ALI induced by APAP.

Topics: Acetaminophen; Alanine Transaminase; Analgesics, Non-Narcotic; Animals; Antidotes; Aspartate Aminotransferases; Chemical and Drug Induced Liver Injury; Cystine; Disease Models, Animal; Drug Overdose; Glutathione; Male; Mice; Mice, Inbred C57BL; Time Factors; Treatment Outcome

Two cases of unintentional paracetamol overdose are presented. Over a one month period these patients presented to an Accident and Emergency (A&E) department with symptoms of paracetamol toxicity, following the ingestion of large quantities of analgesia for the self treatment of dental pain. In one case the patient had no access to a dentist. Both patients required admission under the care of the medical on-call team and required anti-toxicity treatment to prevent permanent liver injury. Subsequent referrals were made to the oral and maxillofacial surgery team who provided emergency dental treatment and advice on further dental care. This paper highlights the significant signs and symptoms of paracetamol overdose about which dental practitioners should be aware. It also describes the management principles required to prevent potentially life threatening liver damage. Discussion is also made of the potential impact on patients struggling to cope with pulpal pain without access to a general dental practitioner.

Topics: Acetaminophen; Adult; Analgesics, Non-Narcotic; Analgesics, Opioid; Antidotes; Chemical and Drug Induced Liver Injury; Cystine; Drug Overdose; Female; Humans; Male; Nerve Block; Pulpitis; Toothache

Topics: Acetaminophen; Analgesics, Non-Narcotic; Cystine; Drug Labeling; Drug Overdose; Humans

A case of accidental paracetamol overdose in a patient suffering from pericoronitis is described. Self-medication with paracetamol was exacerbated by the prescription of a compound analgesic containing paracetamol by the patient's dental practitioner. The consequent overdose of paracetamol resulted in liver toxicity and acute liver failure. The hazards of accidental paracetamol overdose are discussed and analgesic preparations containing paracetamol described.

Topics: Acetaminophen; Acute Kidney Injury; Adult; Cystine; Dextropropoxyphene; Drug Combinations; Drug Overdose; Humans; Male; Pericoronitis; Renal Dialysis; Self Medication

Topics: Acetaminophen; Cystine; Drug Overdose; Emergency Nursing; Humans