Late Diagnosis of Paracetamol Poisoning is Always Lethal in Young Adult

Acetaminophen has a remarkable safety profile when prescribed in proper therapeutic doses, but hepatotoxicity can occur when misused or after an overdose. The principal toxic metabolite of acetaminophen is N-acetyl-p-benzoquinone imine (NAPQI). Toxicity should be considered in all suspicious cases because of the ubiquitous and initially asymptomatic nature of acetaminophen intoxication. A case of 29-year male soldier is discussed, who presented with pain in abdomen, vomiting and jaundice of sudden onset. The diagnosis of ischemic liver damage was made at initial presentation. Raised liver function tests and elevated prothrombin time were the first indication to this condition, which were proven by detection of acetaminophen in blood and urine by liquid chromatography-mass spectrometry. Further supportive evidence of hepatic necrosis was provided by an ultrasound abdomen, giving the final diagnosis of acetaminophen poisoning causing drug-induced liver injury. Key Words: Acetaminophen poisoning, Drug-induced liver injury, Fulminant hepatic failure, N-acetylcysteine, N-acetyl-p-benzoquinone imine (NAPQI).