Massive intoxication with acetaminophen and propoxyphene: Unexpected survival and unusual pharmacokinetics of acetaminophen

Susan M. Pond, Theodore G Tong, George A. Kaysen, David J. Menke, Raymond E. Galinsky, Stephen M. Roberts, Gerhard Levy

Research output: Contribution to journalArticle

15 Scopus citations


A 28-year-old woman ingested an estimated 58 g acetaminophen and 9 g propoxyphene 20 h before hospitalization. Her serum acetaminophen concentration at 22 h was 485 μg/mL and declined with an unusually long half-life of 14 h. Hemodialysis for 4 h (started at 36 h) reduced the acetaminophen concentration from 250 to 32 μg/mL. The patient's complete recovery was remarkable because of the large amounts of drugs ingested, the delayed treatment, and prior exposure to enzyme inducers (known to increase acetaminophen hepatotoxicity). Administration of N-acetylcysteine prevented inorganic sulfate depletion usually caused by acetaminophen and may have increased the formation of acetaminophen sulfate. Some patients eliminate large overdoses of acetaminophen very slowly. Measures to enhance the elimination of this drug and its toxic metabolite by these individuals may be useful even when diagnosis or hospitalization is delayed.

Original languageEnglish (US)
Pages (from-to)1-16
Number of pages16
JournalClinical Toxicology
Issue number1
Publication statusPublished - 1982
Externally publishedYes


ASJC Scopus subject areas

  • Toxicology
  • Medicine(all)

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