Early metabolic acidosis and coma after acetaminophen ingestion

Metabolic acidosis and coma may develop in patients who experience severe h epatic injury after acetaminophen poisoning. The onset of acidosis and coma soon after acetaminophen overdose, but preceding manifest hepatic injury, contrasts with the typical course of poisoning, This pattern has been repor ted in a limited number of cases. Coingestions and the rare occurrence of t hese findings after an overdose have engendered controversy as to whether a cetaminophen alone is the cause of early coma and acidosis. We describe 4 s eparate overdoses among 3 patients who arrived at the emergency department comatose with a metabolic acidosis soon after ingesting large amounts of ac etaminophen without evidence of toxic liver injury. Our cases support the v iew that early metabolic acidosis with coma does indeed occur after acetami nophen poisoning, independent of hepatic failure or its complications.