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      Multiple Organ Transplantation after Suicide by Acetaminophen and Gunshot Wound

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          Abstract

          Emergency physicians (EP) and medical toxicologists are integral in identifying and treating patients with overdoses. Transplant centers are expanding acceptance criteria to consider those with poison-related deaths. We present a case of a simultaneous gunshot wound to the head and an acetaminophen overdose. This case highlights the importance of EPs and medical toxicologists in recognizing the medical complexity of suicides, optimizing treatment, and timing of organ procurement. Early antidote administration and aggressive supportive care allowed the patient to be evaluated as a potential donor. EPs and medical toxicologists have integral roles in overdose patients as organ donors.

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          Most cited references12

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          Paracetamol overdosage. Pharmacological considerations and clinical management.

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            Acetaminophen overdose. 662 cases with evaluation of oral acetylcysteine treatment.

            Six hundred sixty-two consecutive patients with acetaminophen overdoses were evaluated. Those at risk on the basis of their acetaminophen blood levels, as plotted on the study nomogram, were treated with oral acetylcysteine. Statistically significant differences in severity of hepatic toxicity were observed between patients treated within 16 hours after ingestion and those treated between 16 and 24 hours after ingestion. No deaths occurred among patients treated within 24 hours of ingestion, except for one patient who was an alleged gunshot homicide. Seven percent of patients with plasma acetaminophen levels in the potentially toxic range and treated with acetylcysteine within ten hours of ingestion showed transient SGOT level elevations, whereas 29% of those treated between ten and 16 hours after ingestion and 62% of those treated between 16 and 24 hours after ingestion showed such transient toxicity. No consistent difference in hepatotoxicity could be demonstrated between those patients with a history of chronic alcohol use and those patients with no history of chronic alcohol use. Acute alcohol use resulted in less severe toxic reactions than in those patients without acute alcohol use.
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              Plasma-paracetamol half-life and hepatic necrosis in patients with paracetamol overdosage.

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                Author and article information

                Journal
                West J Emerg Med
                WestJEM
                Western Journal of Emergency Medicine
                Department of Emergency Medicine, University of California, Irvine School of Medicine
                1936-900X
                1936-9018
                December 2010
                : 11
                : 5
                : 506-509
                Affiliations
                [* ] University of California, Davis, Department of Emergency Medicine, Davis, CA
                [] University of California, Davis, Department of Surgery, Davis, CA
                [] University of California, Davis, Department of Medicine, Davis, CA
                Author notes
                Address for Correspondence: Mark Sutter, MD, Department of Emergency Medicine, University of California, Davis 2315 Stockton Blvd, Sacramento CA, 95817. Email: mark.sutter@ 123456ucdmc.ucdavis.edu .

                Supervising Section Editor: Brandon K. Wills, DO, MS

                Article
                wjem11_5p506
                3027447
                21293774
                3faf4539-7000-4517-9477-0abb308ae535
                Copyright © 2010 the authors.

                This is an Open Access article distributed under the terms of the Creative Commons Non-Commercial Attribution License, which permits its use in any digital medium, provided the original work is properly cited and not altered. For details, please refer to http://creativecommons.org/licenses/by-nc-nd/3.0/. Authors grant Western Journal of Emergency Medicine a nonexclusive license to publish the manuscript.

                History
                : 26 March 2010
                : 10 May 2010
                Categories
                Education/Academic Medicine
                Case Report

                Emergency medicine & Trauma
                Emergency medicine & Trauma

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