Pancytopenia, hyperglycemia, shock, coma, rhabdomyolysis, and pancreatitisassociated with acetaminophen poisoning

It is well recognized that acetaminophen overdose can cause severe hepatic injury. However, extra-hepatic manifestations may also develop following in appropriate use or ingestion of large amounts of acetaminophen. We present a 44-y-o female who manifested coma, metabolic acidosis, shock, hypothermia , hyperglycemia, rhabdomyolysis, hepatotoxicity, and renal insufficiency af ter suicidal ingestion of an unknown amount of acetaminophen. Although her consciousness and hemodynamic status graduals improved after treatment with N-acetylcysteine and other supportive measures, she was found to have panc ytopenia, pancreatitis and hepatorenal failure during the hospitalization a nd eventually died 18 d post-admission. Review of relevant literature repor ts and the clinical findings in our patient suggests that direct toxic effe cts mediated by acetaminophen or its metabolites were most liked responsibl e for most of the observed clinical features.