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Acute Renal Impairment in Patients Due to Paracetamol Overdose in the Absence of Hepatic Impairment

In general, paracetamol poisoning is associated with hepatotoxicity and very rarely with renal impairment in the absence of significant hepatic impairment. Paracetamol poisoning associated with renal impairment is rare, and it is mostly associated with hepatotoxicity. Most patients with acute renal...

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Autores principales: Khan, Zahid, Abumedian, Mohammed, Ibekwe, Mildred, Musa, Khalid, Mlawa, Gideon
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8790541/
https://www.ncbi.nlm.nih.gov/pubmed/35111421
http://dx.doi.org/10.7759/cureus.20727
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author Khan, Zahid
Abumedian, Mohammed
Ibekwe, Mildred
Musa, Khalid
Mlawa, Gideon
author_facet Khan, Zahid
Abumedian, Mohammed
Ibekwe, Mildred
Musa, Khalid
Mlawa, Gideon
author_sort Khan, Zahid
collection PubMed
description In general, paracetamol poisoning is associated with hepatotoxicity and very rarely with renal impairment in the absence of significant hepatic impairment. Paracetamol poisoning associated with renal impairment is rare, and it is mostly associated with hepatotoxicity. Most patients with acute renal impairment show a pattern of acute tubular necrosis or injury based on their blood, clinical presentation, and imaging. The level of injury was found to be associated with the dose of paracetamol taken. We describe a case of a 22-year-old patient presenting to the hospital with abdominal pain, back pain, and two episodes of vomiting after 36 hours of an intentional paracetamol overdose of 60 tablets. His lab results showed raised creatinine levels and C-reactive protein (CRP) despite normal liver function tests. His paracetamol and salicylate levels were not checked on his initial presentation. He was given N-acetyl cysteine (NAC) treatment for paracetamol overdose and had computed tomography of kidneys, ureters, and bladder (CT KUB) the following day, which showed mild, uncomplicated sigmoid diverticula. He was discharged the next day, but was readmitted two days later with severe abdominal pain and worsening renal function. He had an magnetic resonance imaging (MRI) abdomen that showed coronal/axial wedge like areas of relative hypo-intense change in the T2 acquisition. He received intravenous fluids and antibiotics, and his renal function improved. He was discharged home with outpatient follow-up and appeared to be fully recovered.
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spelling pubmed-87905412022-02-01 Acute Renal Impairment in Patients Due to Paracetamol Overdose in the Absence of Hepatic Impairment Khan, Zahid Abumedian, Mohammed Ibekwe, Mildred Musa, Khalid Mlawa, Gideon Cureus Nephrology In general, paracetamol poisoning is associated with hepatotoxicity and very rarely with renal impairment in the absence of significant hepatic impairment. Paracetamol poisoning associated with renal impairment is rare, and it is mostly associated with hepatotoxicity. Most patients with acute renal impairment show a pattern of acute tubular necrosis or injury based on their blood, clinical presentation, and imaging. The level of injury was found to be associated with the dose of paracetamol taken. We describe a case of a 22-year-old patient presenting to the hospital with abdominal pain, back pain, and two episodes of vomiting after 36 hours of an intentional paracetamol overdose of 60 tablets. His lab results showed raised creatinine levels and C-reactive protein (CRP) despite normal liver function tests. His paracetamol and salicylate levels were not checked on his initial presentation. He was given N-acetyl cysteine (NAC) treatment for paracetamol overdose and had computed tomography of kidneys, ureters, and bladder (CT KUB) the following day, which showed mild, uncomplicated sigmoid diverticula. He was discharged the next day, but was readmitted two days later with severe abdominal pain and worsening renal function. He had an magnetic resonance imaging (MRI) abdomen that showed coronal/axial wedge like areas of relative hypo-intense change in the T2 acquisition. He received intravenous fluids and antibiotics, and his renal function improved. He was discharged home with outpatient follow-up and appeared to be fully recovered. Cureus 2021-12-27 /pmc/articles/PMC8790541/ /pubmed/35111421 http://dx.doi.org/10.7759/cureus.20727 Text en Copyright © 2021, Khan et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Nephrology
Khan, Zahid
Abumedian, Mohammed
Ibekwe, Mildred
Musa, Khalid
Mlawa, Gideon
Acute Renal Impairment in Patients Due to Paracetamol Overdose in the Absence of Hepatic Impairment
title Acute Renal Impairment in Patients Due to Paracetamol Overdose in the Absence of Hepatic Impairment
title_full Acute Renal Impairment in Patients Due to Paracetamol Overdose in the Absence of Hepatic Impairment
title_fullStr Acute Renal Impairment in Patients Due to Paracetamol Overdose in the Absence of Hepatic Impairment
title_full_unstemmed Acute Renal Impairment in Patients Due to Paracetamol Overdose in the Absence of Hepatic Impairment
title_short Acute Renal Impairment in Patients Due to Paracetamol Overdose in the Absence of Hepatic Impairment
title_sort acute renal impairment in patients due to paracetamol overdose in the absence of hepatic impairment
topic Nephrology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8790541/
https://www.ncbi.nlm.nih.gov/pubmed/35111421
http://dx.doi.org/10.7759/cureus.20727
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