IPLab:Lab 12:Acetaminophen Toxicity - Revision history

Peter Anderson: /* Autopsy Findings */

2020-07-09T21:11:16Z

‎Autopsy Findings

Peter Anderson: /* Clinical Summary */

2020-07-09T21:11:07Z

‎Clinical Summary

Peter Anderson: /* Virtual Microscopy */

2015-09-16T19:26:42Z

‎Virtual Microscopy

Seung Park at 16:37, 3 January 2014

2014-01-03T16:37:10Z

Seung Park: /* Images */

2013-08-30T01:47:46Z

‎Images

Seung Park: /* Images */

2013-08-26T14:57:54Z

‎Images

Seung Park: /* Journal Articles */

2013-08-26T14:55:04Z

‎Journal Articles

Seung Park: /* Reference */

2013-08-26T14:53:29Z

‎Reference

Peter Anderson at 18:50, 25 August 2013

2013-08-25T18:50:11Z

Seung Park at 04:26, 23 August 2013

2013-08-23T04:26:40Z

← Older revision		Revision as of 21:11, 9 July 2020
Line 3:		Line 3:

	At autopsy the liver had large areas of pale softened tissue indicative of liver necrosis.		At autopsy the liver had large areas of pale softened tissue indicative of liver necrosis.
−
−	~~== Autopsy Findings ==~~
−	There were petechia and ecchymoses all over the body. The skin on the hands, feet, and in patches over the entire body was deep purple, the epidermis was friable and there were large areas of desquamation. The fingertips and toes were black and dry. The liver had large areas of pale softened tissue indicative of liver necrosis.

	== Images ==		== Images ==

@@ Line 1: / Line 1: @@
 == Clinical Summary ==
-This 77-year-old white male with a past medical history of osteo- and rheumatoid arthritis went to his internist for treatment of increasing joint pain and was started on a muscle relaxant, a narcotic analgesic that also contained 650 mg of acetaminophen, and a non-steroidal anti-inflammatory agent. The patient's medical record also indicated that he self medicated with acetaminophen. Two days later he went back to his doctor complaining of nausea and vomiting, right upper quadrant pain, anorexia, and confusion. Lab evaluation revealed increased liver function tests (AST, 2190; ALT, 1959; LDH, 5020; alkaline phosphatase, 120; GGT, 125; total bilirubin, 3.9). Hepatitis serologies were negative. The patient's blood acetaminophen level was 45 mcg/dL. Over the next several days the patient began to develop petechiae which progressed to ecchymosis and necrosis of his hands and feet. Laboratory studies revealed that the liver function was improving, but coagulation studies were consistent with DIC (platelets, 19,000; FDP, greater than 40; fibrinogen, 90; PTT, 26). The patient was treated with heparin, cryoprecipitate, fresh frozen plasma, and anti-thrombin III. Despite improvement in his coagulation parameters, the patient appeared to have ongoing thrombosis. The patient was evaluated by orthopedic and vascular surgery who recommended bilateral below-the-knee amputations and bilateral hand amputations. However, the patient was found apneic and, in keeping with his request that he not be resuscitated, no resuscitative measures were undertaken.
+At autopsy the liver had large areas of pale softened tissue indicative of liver necrosis.
 == Autopsy Findings ==

@@ Line 19: / Line 19: @@
 == Virtual Microscopy ==
 <peir-vm>IPLab12Acetaminophen</peir-vm>
 == Study Questions ==

@@ Line 4: / Line 4: @@
 == Autopsy Findings ==
 There were petechia and ecchymoses all over the body. The skin on the hands, feet, and in patches over the entire body was deep purple, the epidermis was friable and there were large areas of desquamation. The fingertips and toes were black and dry. The liver had large areas of pale softened tissue indicative of liver necrosis.
@@ Line 18: / Line 17: @@
 File:IPLab12Acetaminophen8.jpg|This is a higher-power photomicrograph of the skin from this patient showing a blister and the thrombosed small vessels (arrows) in the dermis.
 </gallery>
 == Study Questions ==

@@ Line 36: / Line 36: @@
 === Images ===
-* [http://peir.path.uab.edu/library/index.php?/tags/2169-acetaminophen_toxicity PEIR Digital Library: Acetaminophen Toxicity Images]
+* [{{SERVER}}/library/index.php?/tags/2169-acetaminophen_toxicity PEIR Digital Library: Acetaminophen Toxicity Images]
 * [http://library.med.utah.edu/WebPath/LIVEHTML/LIVERIDX.html WebPath: Hepatic Pathology]

@@ Line 32: / Line 32: @@
 === Journal Articles ===
+* Schiødt FV, Lee WM, Bondesen S, Ott P, Christensen E.  [http://www.ncbi.nlm.nih.gov/pubmed/11929388 Influence of acute and chronic alcohol intake on the clinical course and outcome in acetaminophen overdose].  ''Aliment Pharmacol Ther'' 2002 Apr;16(4):707-15.
 === Images ===

@@ Line 27: / Line 27: @@
 == Additional Resources ==
 === Reference ===
+* [http://emedicine.medscape.com/article/820200-overview eMedicine Medical Library: Acetaminophen Toxicity]
 === Journal Articles ===

@@ Line 24: / Line 24: @@
 Adverse drug reactions can occur with therapeutic agents, but in this case the most probable cause for liver necrosis was the unintentional overdose of acetaminophen by this patient who was not aware that one of the new drugs he was taking already contained acetaminophen.</spoiler>
 * <spoiler text="Why did this patient develop DIC?">Liver necrosis releases thromboplastin and can initiate the coagulation cascade leading to intravascular coagulation.</spoiler>
 {{IPLab 12}}
 [[Category: IPLab:Lab 12]]