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→Autopsy Findings
== Clinical Summary ==
This 77-year-old white male with a past medical history of severe osteo- and rheumatoid arthritis went to his internist for increasing joint pain and was started on a new medication containing a narcotic analgesic, acetaminophen, and a non-steroidal anti-inflammatory agent. The patient also 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 massively increased liver enzymes. The patient went into DIC and died in fulminant liver failure.
== Images ==
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.
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== Virtual Microscopy ==
=== Liver: Acetominophen Toxicity ===
<peir-vm>IPLab12Acetaminophen</peir-vm>
=== Normal Liver ===
<peir-vm>UAB-Histology-00149</peir-vm>
== Study Questions ==
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>
== Additional Resources ==
=== Reference ===
* [http://emedicine.medscape.com/article/820200-overview eMedicine Medical Library: Acetaminophen Toxicity]
* [http://emedicine.medscape.com/article/177354-overview eMedicine Medical Library: Acute Liver Failure]
* [http://www.merckmanuals.com/professional/injuries_poisoning/poisoning/acetaminophen_poisoning.html Merck Manual: Acetaminophen Poisoning]
=== 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.
* Yeates PJ, Thomas SH. [http://www.ncbi.nlm.nih.gov/pubmed/10606832 Effectiveness of delayed activated charcoal administration in simulated paracetamol (acetaminophen) overdose]. ''Br J Clin Pharmacol'' 2000 Jan;49(1):11-4.
=== 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]
== Related IPLab Cases ==
{{IPLab 12}}
[[Category: IPLab:Lab 12]]