Posterior reversible encephalopathy syndrome following iatrogenic acetylcysteine overdose: a case report

We present a case of posterior reversible encephalopathy syndrome (PRES) linked to N-acetylcysteine (NAC) overdose during treatment for acetaminophen overdose. The patient presented to the emergency department following the ingestion of 455 mg/kg of acetaminophen and was administered a total of 46.2...

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Bibliographic Details
Published in:Toxicology communications 2023-12, Vol.7 (1)
Main Authors: Jae, James, Li, Yilong, Mackenzie, Constance A.
Format: Article
Language:English
Subjects:
Acetaminophen
Acetylcysteine
Ammonia
Analgesics
Blood pressure
case report
Case reports
Drug dosages
Drug overdose
Edema
Emergency medical care
Encephalopathy
Epilepsy
Iatrogenesis
Magnetic resonance imaging
N-acetylcysteine
Neuroimaging
Overdose
Patients
Poisons
Posterior reversible encephalopathy syndrome
Renal replacement therapy
Seizures
Toxicology
Citations: Items that this one cites
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Description
Summary:We present a case of posterior reversible encephalopathy syndrome (PRES) linked to N-acetylcysteine (NAC) overdose during treatment for acetaminophen overdose. The patient presented to the emergency department following the ingestion of 455 mg/kg of acetaminophen and was administered a total of 46.2 g of NAC over 14 h in error, compared to the intended 19.8 g. She subsequently developed status epilepticus. After seizure control, brain imaging by CT and MRI showed PRES. Continuous renal replacement therapy (CRRT) was started to eliminate NAC and acetaminophen. The patient eventually recovered neurologically with improved transaminases and was free of further seizures.
ISSN:2473-4306
2473-4306
DOI:10.1080/24734306.2023.2292879