DOUBLE-PEAKED ACETAMINOPHEN CONCENTRATION SECONDARY TO INTESTINAL TRAUMA

Main Article Content

B. Alyahya
S. Tamur
S. Aljenedil
A. Larocque
E. Holody
S. Gosselin

Keywords

Acetaminophen, intestinal trauma, gastrointestinal motility, toxicokinetics

Abstract

Background


Reduced gastrointestinal motility can alter the toxicokinetics of acetaminophen poisoning. We report a case of altered acetaminophen toxicokinetics due to delayed gastrointestinal absorption, likely secondary to intestinal trauma/surgery.


Case Report


A 37- year -old woman ingested an unknown amount of acetaminophen and ethanol then stabbed herself in the abdomen. The initial acetaminophen was 1,285.9 μmol/L and the time of ingestion was not known. Intravenous acetylcysteine protocol was started. She devel oped an ileus post -surgery for the stab wounds. At 31 hours post -presentation, the acetaminophen returned undetectable, and the transaminases were normal. After the resolution of the ileus, repeated acetaminophen peaked at 363.3 μmol/L 52 hours post - admission. At 76 hours post -admission, the acetaminophen was undetectable, and transaminases and coagulation parameters were normal.


Conclusions


Reduction in gastrointestinal motility secondary to trauma and/or surgery must be considered when determining when t o initiate or discontinue treatment as well as how long to monitor acetaminophen concentrations.

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