Humayun Bakht Mirza, Shabeer Hussain, Ghulam Ali, Kamran.
Paracetamol Toxicity.
J Surg Pak Jan ;4(2):34-6.

Paracetamol is one of the most widely and freely medicine world over.Its side effects are rare but one must be aware of them and diagnose them early before they became fatal. One such case of paracetamol toxicity is reported which had a fatal out come.

Case History: A 25-year married young American national of Pakistan origin presented with history of ingestion of 50 tablets of Tynalol (paracetamol) 500mg at National Poison Control Centre JPMC, Karachi. He came to the hospital four days after ingestion of the drug, in semi comatose condition with deep jaundice. This was his second suicidal attempt. He was given injections Ringers lactate and Furesamide (Lasix) at home by his aunt who is a general practioner and a Gynaecologist. She told him that she usually takes upto 10-12 tablets of Paracetamol 500mg daily as it does not cause any harm and is nontoxic. On admission the patient was toxic and jaundiced. His temperature was 98F, blood pressure 160/70 mmHg of Hg and heart rate 140 per minute. He was unconscious, responding minimally to very painful stimuli. Pupils were dilated with sluggish reaction to light and Doll`s eye movements were present. Glasgow Coma Scale was 6/15. His respiration was 28 per minute with episodic breathing and coarse crepitation in the right side of chest. His abdomen was tense but gut sounds were present. The patient was immediately put on ventilator. Twentyeight bags of fresh frozen plasma and concentrated platelets were infused. He was provided with antibiotic cover and Vitamin K 10 mg. The antidote of paracetamol, N-acetyl cystine 140 mg/kg was given at the time of admission and 70 mg/kg body weight every 5-hours through nasogastric tube. The patient initially improved slightly but suddenly deteriorated and died on the third day of admission. His total duration of stay in hospital was from 12th March (11.30 pm) to 15th March (7.30 am).

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