Case Files from the University of California San Diego Health System Fellowship Coma and Severe Acidosis: Remember to Consider Acetaminophen

A 28-year-old man was brought to the Emergency Department (ED) for evaluation of a depressed level of consciousness that developed while in jail. Qualitative comprehensive urine and serum drug screening by immunoassay, gas chromatographymass spectrometry, and liquid chromatography-tandem mass spectr...

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Bibliographic Details
Published in:Journal of medical toxicology 2015-09, Vol.11 (3), p.368-376
Main Authors: Villano, Janna H., O’Connell, Charles W., Ly, Binh T., Schneir, Aaron
Format: Article
Language:English
Subjects:
Acetaminophen
Acetaminophen - blood
Acetaminophen - pharmacokinetics
Acetaminophen - poisoning
Acetylcysteine - administration & dosage
Acidosis
Acidosis, Lactic - blood
Acidosis, Lactic - chemically induced
Acidosis, Lactic - diagnosis
Acidosis, Lactic - therapy
Adult
Analgesics
Antidotes - administration & dosage
Biomarkers - blood
Biomedical and Life Sciences
Biomedicine
Caffeine
Coma
Coma - blood
Coma - chemically induced
Coma - diagnosis
Coma - therapy
Creatinine
Drug Overdose
Drug screening
Emergency medical services
Gas chromatography
Humans
Immunoassay
Infusions, Intravenous
Lactic acid
Liquid chromatography
Male
Mass spectrometry
Mass spectroscopy
Organic acids
Pharmacology/Toxicology
Poisoning - diagnosis
Poisoning - etiology
Predictive Value of Tests
Prisoners
Prisons
Pyroglutamic acid
Pyruvic acid
Risk Factors
Screening
Severity of Illness Index
Side effects
Spectroscopy
Toxicology
Toxicology Case File
Treatment Outcome
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Description
Summary:A 28-year-old man was brought to the Emergency Department (ED) for evaluation of a depressed level of consciousness that developed while in jail. Qualitative comprehensive urine and serum drug screening by immunoassay, gas chromatographymass spectrometry, and liquid chromatography-tandem mass spectrometry revealed only acetaminophen and caffeine. Urine screening for organic acids revealed elevated concentrations of acetaminophen, lactic acid, and pyruvic acid. The excretion of 5-oxoproline (pyroglutamic acid) was reported as mildly above 400 mmol/mol creatinine, the upper limit of the normal reference range.
ISSN:1556-9039
1937-6995
DOI:10.1007/s13181-015-0492-x