A 31 yo man was brought to the ED after being found unresponsive. His wife reports he had been having lots of back pain after falling at work and was taking “some pills” for it. She also tells you that he drinks heavily every day, and has no history of illicit drug use. He is intubated in the ICU and on admission his vitals are: T35.5, HR 130, BP 70/40, RR 36 with O2 sat 100% on TV 500 RR 20 FiO2 40% PEEP 5.
Labs reveal: Na 140 K5.5 Cl 100 Bicarb 4 Cr 2.4 Lactate 9.8. CBC, LFTs and coags are normal.
ABG: pO2 90 pCO2 15 pH 6.98 CXR is normal.
Interpret the Acid-Base status of this patient. What additional tests would you order to help identify the toxin?
Volatile alcohol screen is negative.
Which of the following statements is untrue?
The toxin is acetaminophen
This condition may be caused by an autosomal recessive trait
Treat with fomepizole
Treat with NAC
See this article: Crit Care Med 2000; 28:1803-1807
Treat with fomipezole
– with high anion gap metab acidosis which can be seen in both tylenol overdose and ethanol/ethanol ingestion though if it is from acetaminphen it might be from vascular collapse from liver failure + a component of metabolite called 5 oxoproline.
– negative volatile screen
– He drinks heavy and if he ingested tylenol that toxic treshold is lower
– tylenol metabolism has genetic predisoposition because it is dependent of gluthatione stores and generation. therefore a depleted store from gluthathione synthetase dificiency can lead to accumulation of the toxic NAPQ1
– And.. fomipezole is the only one that does not belong in the group