Author: Fiona Mendes / Editor: Yasmin Sultan / Reviewer: Chris Wearmouth, Fiona Mendes / Codes: / Published: 09/02/2024
During the afternoon, a 19-year-old male was lifting heavy weights in the gym and developed lower back pain. His friend advised paracetamol.
To effectively relieve the pain, he takes two tablets of paracetamol every 2-3 hours. He also takes co-codamol at night to help him sleep.
The back pain improves over the course of the following day with more paracetamol. He then develops nausea and abdominal pain later in the day for which he takes more painkillers.
His girlfriend finds him later in the evening and is worried he took more paracetamol than was advised on the packaging and drives him to your Emergency Department (ED).
He is seen by the junior ED doctor who establishes that he has taken 7g of paracetamol in a 24 hour period, equivalent to 100mg/kg. He is admitted to CDU after starting an acetylcysteine infusion.
This patient has well-controlled asthma and requires his salbutamol inhalers infrequently. He is usually fit and well. He is not taking any other medications. He has no known drug allergies. He has no suicidal thoughts or intent.
Whilst on CDU, towards the end of the first bag of the acetylcysteine infusion, he develops a widespread rash and complains of feeling unwell with chest tightness, nausea and starts vomiting. His faced is flushed and he has a mild wheeze. Observations are normal except for a tachycardia.
The CDU nurse calls you to review and manage this patient.
Fig.1 Image via Shutterstock
