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

• Published in: Journal of medical toxicology Vol. 11; no. 3; pp. 368 - 376
• Main Authors: Villano, Janna H., O’Connell, Charles W., Ly, Binh T., Schneir, Aaron
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.09.2015; Springer Nature B.V
• 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; Acidosis; Acetaminophen; Arteriolization
• ISSN: 1556-9039; 1937-6995
• DOI: 10.1007/s13181-015-0492-x

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.