Ingested 2

Multisystem Processes & Disorders


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M55_F22.jpg"}},{"insert":"\n\nYour shift in the ED has been relaxed (relatively speaking) so far\u2014and you are still full of energy.\n\n\u201cDoctor, you\u0027ve got a new patient,\u201d your nurse says.\n\nYou are introduced to Jon, a 67-year-old retired police officer. He is accompanied by his wife, Martha.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M55_F24.jpg"}},{"insert":"\n\nJon begins, \u201cDoctor, I\u0027ve been in pain since day-before-yesterday. It\u0027s my tooth.\u201d He stops to open his mouth and point at the right lower second molar tooth. \u201cI\u0027ve\u2014\u201d\n\nMartha abruptly cuts in, \u201cthat\u0027s not the problem! Doctor, he\u0027s been taking Tylenol like candy. I just found out that he\u0027d had a dozen tablets just yesterday, and I brought him to hospital right away. I know that it\u0027s not safe to have so many so quickly\u201d\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M55_F25.jpg"}},{"insert":"\n\nMartha\u0027s statement makes you stand up and take notice. Inquiring further, you find out that Jon has had 24 tablets of acetaminophen (paracetamol) 500 mg over the last 48 hours. His most recent dose was two tablets around three hours ago.\n\nAside from the toothache, Jon has no other symptoms. He was diagnosed with essential hypertension seven years ago, which is well controlled on Losartan. He is not on any other medications. His most recent health evaluation was six month ago; at that time, a fasting plasma glucose, HbA1c, and lipid profile were all normal.\n\nJon only drinks socially, has never smoked, and laughs when you ask him about recreational drug use. \u201cWouldn\u0027t be right for a police officer, would it, doctor?\u201d\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M55_F12.jpg"}},{"insert":"\n\nOn examination, Jon is\u00a0alert and oriented. His vital signs are stable, with a blood pressure of 135\/90 mmHg. Examination of the heart, lungs, and abdomen reveals no abnormalities.\n"}]}


{"ops":[{"insert":"Examination over, you run over the possibilities.\n\nWhich of the following are you thinking of?\n"}]}
1. Acute acetaminophen overdose
2. Repeated supratherapeutic ingestion
3. Neither of the above