We present a case of a 20-year-old female presenting with an acute ingestion of over 120 grams (1764.7 mg/kg) and an acetaminophen concentration of 5880 μmol/L who developed refractory shock, decreased level of consciousness, and metabolic acidosis requiring mechanical ventilation and vasopressor support. In such ingestions, the role of adjuvant treatments such as fomepizole and extracorporeal removal is unclear. However, there is less clarity in the management of massive overdoses (acute, single mg/kg with 4-hour equivalent concentrations ~6000 μmol/L) which are often associated with metabolic acidosis and multiorgan dysfunction. ![]() There is strong evidence for N-acetylcysteine (NAC) as a safe and effective antidote for acetaminophen toxicity. ![]() Acetaminophen overdose is one of the most common causes of acute hepatic failure in the developed world.
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