ST segment elevation secondary to paracetamol overdose

Abstract

Paracetamol is the most common drug employed in self-poisoning in the UK, with 25,000 admissions from paracetamol poisoning recorded in 2001 alone [Morgan et al. 2005]. The toxic effects of paracetamol on the hepatic and renal systems are well documented, but it is less publicized that paracetamol and its metabolites can have toxic effects on other organ systems including the myocardium [Jones and Prescott, 1997]. We present a case of paracetamol poisoning causing toxic myocardial damage. Case report A 68-year-old woman self-presented 12 h after taking a 25-g paracetamol overdose. She had no past medical history of note and was not currently taking any medications. Clinically she was asymptomatic but was noted to be mildly hypotensive. Serum paracetamol level at presentation was 23 mg/l (reference range: 1020 mg/l at 4 h post-ingestion), but other blood results including arterial blood gases were unremarkable.

A study on paracetamol cardiotoxicity

“…In contrast, there have been a few very rare cases of paracetamol overdose reported with abnormal ECG patterns in the absence of hepatotoxicity, metabolic derangement or encephalopathy [ 32 , 43 ]. A similar case of a 29 year old man with significant paracetamol overdose was found to have an abnormal ECG in the absence of hepatic encephalopathy [ 9 ].…”