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Death from paracetamol overdose despite appropriate treatment with n-acetylcysteine
  1. Chris Bourdeaux,
  2. Jeremy Bewley
  1. Department of Anaesthesia, Bristol Royal Infirmary, Bristol, UK
  1. Correspondence to:
 Dr C Bourdeaux
 Department of Anaesthesia, Level 7, Queens Building, Bristol Royal Infirmary, Bristol BS2 8HW, UK; chrisbourdeaux{at}


A case of death from severe paracetamol poisoning which presented early and received appropriate treatment according to evidence-based guidelines is presented here. It is very rare for patients to die from paracetamol poisoning when they receive N-acetylcysteine (NAC) within 8 h of ingestion. The patient had a marked lactic acidosis on presentation to hospital. This case demonstrates that a patient can die from paracetamol poisoning despite early and appropriate treatment, and raises the question whether lactic acidosis in a patient following paracetamol overdose should prompt the initiation of NAC treatment while awaiting paracetamol levels.

  • ALT, alanine aminotransferase
  • NAC, N-acetylcysteine
  • PT, prothrombin time

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  • Competing interests: None declared.

  • Informed consent was obtained for publication of the person’s details in this report.