Prescription Drugs 2 Go

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DEVELOPMENT OF HEPATIC FAILURE DESPITE USE OF INTRAVENOUS ACETYLCYSTEINE AFTER A MASSIVE INGESTION OF ACETAMINOPHEN AND DIPHENHYDRAMINE. Schwartz EA et al. Ann Emerg Med Sept. 2009;54:421-423.
Abstract
This uncommonly interesting case report describes a 48-year-old woman who ingested 150 tablets of Tylenol PM, each containing 500 mg acetaminophen and 25 mg diphenhydramine.  On arrival at hospital, she had clear signs of anticholinergic overdose (tachycardia, dry skin, encephalopathy) but normal liver enzymes and INR.  The initial 4 hour acetaminophen (APAP) level — 104 mcg/ml — was below the treatment line on the Rumack-Mathew nomogram, but since the history was initially unclear intravenous N-acetylcysteine (IV-NAC) was started.  However, the APAP level con…