Persistently elevated acetaminophen concentrations for two days after an initial four-hour non-toxic concentration

The decision to treat patients who overdose with n-acetylcysteine is routin ely made with a single APAP concentration drawn 4 or more hours post-ingest ion. However, in cases where there are co-ingestants that may delay gastric emptying, there have been recommendations for additional concentrations to determine peak APAP concentrations. This report is of a case of acetaminop hen overdose involving narcotic co-ingestants with persistently elevated ac etaminophen concentrations for 2 d, suggesting delayed gastric emptying and /or bezoar formation. A second striking feature of this case was the persis tently elevated acetaminophen concentrations without evidence of liver inju ry despite antidotal therapy not being employed.