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Volume 20, Issue 2 (May 2026)
IJT 2026, 20(2): 0-0 |
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moloudian M, Ghassemi tousi A. Status epilepticus and Hypotension Following Intravenous N-acetylcysteine Lethal Overdose: A Case Report. IJT 2026; 20 (2)
URL: http://ijt.arakmu.ac.ir/article-1-1577-en.html
URL: http://ijt.arakmu.ac.ir/article-1-1577-en.html
1- Medical Toxicology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran/ School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
2- Medical Toxicology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran/ School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran ,ghassemita@mums.ac.ir
2- Medical Toxicology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran/ School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran ,
Abstract: (7 Views)
Background: Acetaminophen (Paracetamol) is the most widely consumed over-the-counter analgesic, but its toxicity is the principal cause of acute liver failure worldwide. For decades, N-acetylcysteine (NAC) has been the standard antidote, working by detoxifying the hepatotoxic metabolite N-acetyl-p-benzoquinoneimine (NAPQI), with treatment initiation guided by the Rumack-Matthew nomogram. While NAC is generally considered safe, it is associated with anaphylactoid reactions, and—more rarely, due to human error—massive overdoses. Reported NAC overdoses have caused severe systemic symptoms, including status epilepticus and profound hypotension, highlighting the risk of iatrogenic harm. A case of fatal NAC massive overdose caused by a medication error is reported in the present study.
Case presentation: A previously healthy young male presented to the ED with an acute acetaminophen overdose; his 4-hour serum level was 220 mcg/dL. A total of 9 gr of intravenous NAC was ordered for the patient. A critical medication error occurred when the nurse administered 90 gr (45 vials) of NAC, tenfold the ordered dose, due to misinterpreting the vial concentration. Forty minutes into the infusion, the patient developed refractory hypotension and seizures, leading to rapid deterioration and death within 1 hour despite aggressive resuscitation efforts.
Conclusion: This case highlights the catastrophic consequences of a massive, preventable medication error (tenfold NAC overdose), leading to death via refractory hypotension and seizures. It critically underscores the need for enhanced safety protocols and rigorous staff competence checks during the preparation and administration of high-risk intravenous medications.
Case presentation: A previously healthy young male presented to the ED with an acute acetaminophen overdose; his 4-hour serum level was 220 mcg/dL. A total of 9 gr of intravenous NAC was ordered for the patient. A critical medication error occurred when the nurse administered 90 gr (45 vials) of NAC, tenfold the ordered dose, due to misinterpreting the vial concentration. Forty minutes into the infusion, the patient developed refractory hypotension and seizures, leading to rapid deterioration and death within 1 hour despite aggressive resuscitation efforts.
Conclusion: This case highlights the catastrophic consequences of a massive, preventable medication error (tenfold NAC overdose), leading to death via refractory hypotension and seizures. It critically underscores the need for enhanced safety protocols and rigorous staff competence checks during the preparation and administration of high-risk intravenous medications.
Keywords: Acetaminophen toxicity, Lack of clinical competence, N-acetylcysteine toxicity, Negligence
Type of Study: case report |
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The Iranian Journal of Toxicology
Arak University of Medical Sciences in collaboration with the Iranian Society of Toxicology
Website: http://ijt.arakmu.ac.ir
Email: tox.journal@gmail.com
