EM/ANAES/CC POSTING

CASE STUDY/ASSIGNMENT-2
EMAIL YOUR Written, Typed or Hand written, 3 pages, PDF Formatted, Answers to the 3
questions below to: abdulali@mahsa.edu.my
Below is a case study put up by one of the students from a previous group:

• A 16-year-old female presents to the emergency department at 0500

with vomiting and nausea. Her mother reports that she (the patient) had
an argument with her boyfriend last night. She woke her mom up early
this morning saying that she feels sick. She admits that last night she
took some pills at 2100. She has vomited 3-4 times at home. Her mom
brought in the bottle of pills. She took acetaminophen 500mg tablets.
Her mother reports it was a new unopened bottle with a quantity of 30
tablets. There are 8 tablets remaining in the bottle (maximum 11 grams
of acetaminophen ingested).
• Exam: VS T 37.2, P 88, R 18, BP 110/70, weight 50kg. She is alert, quiet,
shaking her head yes/no to questions, with poor eye contact. Her skin is
pink with good perfusion. Her oral mucosa is moist. Heart is regular with
a normal rhythm and rate. Lungs are clear with good aeration. Her
abdomen is soft, with normo-active bowel sounds, minimal epigastric
tenderness, no rebound, and no guarding. She is alert, oriented, and
walks about the room without difficulty.
• She is given 50 grams of activated charcoal with sorbitol orally. She is
also given 10 grams of N-acetylcysteine orally. An acetaminophen level,
aspirin level, blood and urine toxicology screen and beta-HCG are drawn.
The acetaminophen level drawn at 8.5 hours post-ingestion is 150
mcg/mL. She is hospitalized for further treatment as well as a psychiatric
evaluation.

Questions:
• 1) What happens to the overdosed paracetamol in the body?
• 2)What are the signs and symptoms of paracetamol poisoning?
• 3)What is the management of paracetamol poisoning?