Ingested
Multisystem Processes & Disorders
0
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M55_F1.jpg"}},{"insert":"\n\n"},{"insert":"Nice weather and light traffic. An unusual combination, especially during the morning rush hour.\n"}]}
1
{"ops":[{"insert":"You arrive at work with a few minutes to spare.\r\n\r\nAs you alight from your car, you notice a colleague getting out from a nearby vehicle.\n\n\u0022That much coffee can\u0027t be good!\u0022, you say, spotting the humongous\u00a0styrofoam cup in his hand.\r\n\r\n\u0022Life without coffee would be even worse\u0022, he responds with a smile.\n"}]}
2
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M55_F3.jpg"}},{"insert":"\n\n"},{"insert":"Side by side, you walk through the doors of the ED.\r\n\r\nThe doctor on call, whom you are to take over from, rushes over when she sees you.\n"}]}
3
{"ops":[{"insert":"\u0022Oh good, you\u0027re a couple of minutes early\u0022, she says.\r\n\r\n\u0022There\u0027s a new admission, seems pretty straightforward: acetaminophen poisoning.\u0022\n\nShe proceeds to bring you up to speed on the new admission.\r\n\r\nMeanwhile, your colleague grins at you wryly and sets off in the\u00a0opposite direction.\n"}]}
4
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M55_F5.jpg"}},{"insert":"\n\n"},{"insert":"Philip Crow, a 24-year-old student, allegedly swallowed around\u00a035 tablets of acetaminophen (paracetamol) 500 mg, around 2 hours ago.\n"}]}
5
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M55_F6.jpg"}},{"insert":"\n\n"},{"insert":"He is accompanied by his girlfriend, Irene, who found him curled up in bed beside the empty blister packs of acetaminophen.\r\n\r\nThere is no evidence to suggest that he may have overdosed on other medications as well.\n"}]}
6
{"ops":[{"insert":"Philip currently complains of nausea and mild abdominal cramping. No other symptoms are present. This is his first attempt at deliberate self-harm.\r\n\r\nHis medical history is unremarkable, and he is not on any medications.\n"}]}
7
{"ops":[{"insert":"He drinks alcohol socially, does not smoke, and denies\u00a0illicit drug use.\r\n\u00a0\n"}]}
8
{"ops":[{"insert":"Philip refused to disclose why he swallowed the tablets.\u00a0\r\n\r\nHowever, Irene stated that he had been unusually withdrawn after receiving a phone call last night. The caller and contents of the call are unknown.\n"}]}
9
{"ops":[{"insert":"Briefing finished, your colleague prepares to end her shift.\u00a0You thank her and\u00a0head over to meet Philip.\n"}]}
10
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M55_F11.jpg"}},{"insert":"\n\n"},{"insert":"You arrive to find him calmly lying down in bed, with his face turned towards the wall.\r\n\r\nYou introduce yourself and take a quick history. No new details of note appear.\n"}]}
11
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M55_F12.jpg"}},{"insert":"\n\n"},{"insert":"You proceed to examine him, which he consents to.\r\n\r\nHis vital signs are stable, he is conscious, rational, and well oriented, and\u00a0the general examination shows no untoward findings.\n"}]}
12
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M55_F11.jpg"}},{"insert":"\n\n"},{"insert":"Examination of the various organ systems reveals no other abnormalities either.\u00a0\n"}]}
13
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M55_F14.jpg"}},{"insert":"\n\n"},{"insert":"Based on a provisional diagnosis of acetaminophen poisoning, you fill out forms for a\u00a0complete blood count, and renal and liver profiles.\r\n\r\nFor what it is worth, you also order a toxicology screen. After all, co-ingestion of multiple poisons is common.\n"}]}
14
{"ops":[{"insert":"\u00a0What is your next course of action?\u00a0\n"}]}
1. Commence IV N-acetylcysteine (NAC) immediately
2. Wait until four hours post ingestion, and then measure serum acetaminophen levels
3. Wait until eight hours post-ingestion, and then measure serum acetaminophen levels
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