Voluntary Ingestion of Dextropropoxyphene-Paracetamol: A Severe Two-Step Intoxication Not to Be Underestimated

Abstract

Dextropropoxyphene overdose is known to cause widening of the QRS complex on electrocardiogram. We report a case of a 18 years old woman who ingested 36 g paracetamol and 2,1 g dextropropoxyphene in suicide attempt. She developed seizures, wide QRS complex and cardiac arrest. The routine blood screening for different psychotropic drugs, opiates and alcohol turned out to be negative. The propoxyphene and paracetamol high concentrations determined in plasma were respectively 4.321 μg/ml at 3.5 hours (lethal value > 2 μg/ml) and 588 μg/ml at 5.0 hours (toxic value > 168 μg/ml). Cardiac arrest consecutive to the toxic effects of dextropropoxyphene on respiratory and cardiac functions usually occurs within one hour after ingestion and before patient reaches hospital.