De-Giorgio Fabio, Lodise Maria, Chiarotti Marcello, d'Aloja Ernesto, Carbone Arnaldo, Valerio Luca
Institute of Legal Medicine Catholic University, School of Medicine, L.go F. Vito, 1 00168, Rome, Italy.
Department of Public Health, Forensic Medicine Section, Cagliari University, Km 4.500 SS. 554 Bivio per Sestu, 09042, Monserrato, Italy.
J Forensic Sci. 2013 Sep;58(5):1397-1400. doi: 10.1111/1556-4029.12205. Epub 2013 Jul 3.
Acetaminophen or paracetamol, a commonly used over-the-counter analgesic, is known to elicit severe adverse reactions when taken in overdose, chronically at therapeutic dosage or, sporadically, following single assumptions of a therapeutic dose. Damage patterns including liver damage and, rarely, acute tubular necrosis or a fixed drug exanthema. We present a case of fatal acetaminophen toxicity with postmortem blood concentration 78 μg/mL and unusual clinical features, including a visually striking and massive epidermolysis and rhabdomyolysis, disseminated intravascular coagulation and myocardial ischemia. This case is compared with the most similar previous reports in terms of organ damage, clinical presentation, and cause of death. We conclude that a number of severe patterns of adverse effects to acetaminophen are emerging that were previously greatly underestimated, thus questioning the adequacy of the clinical spectrum traditionally associated with acetaminophen intoxication and leading to the need to review this spectrum and the associated diagnostic criteria.
对乙酰氨基酚，一种常用的非处方镇痛药，已知在过量服用、长期按治疗剂量服用或偶尔单次服用治疗剂量后会引发严重不良反应。损害模式包括肝损伤，很少见的急性肾小管坏死或固定性药疹。我们报告一例对乙酰氨基酚中毒致死病例，死后血液浓度为78μg/mL，具有不寻常的临床特征，包括外观显著且广泛的表皮松解和横纹肌溶解、弥散性血管内凝血和心肌缺血。将该病例与之前最相似的报告在器官损害、临床表现和死因方面进行了比较。我们得出结论，对乙酰氨基酚出现了一些以前被严重低估的严重不良反应模式，从而对传统上与对乙酰氨基酚中毒相关的临床谱的充分性提出质疑，并导致需要重新审视这一临床谱及相关诊断标准。
