Cardiotoxicity due to paracetamol overdose - a case study and review of the literature

Paracetamol is considered a safe analgesic and antipyretic drug. Cardiac toxicity has also been speculated to be a serious complication in paracetamol poisoning. Most of the claims made for paracetamol cardiotoxicity have been based on postmortem findings in patients who developed fulminant hepatic failure. A 24- year-old man reportedly ingested 50 tablets of 325 mg paracetamol. He presented to hospital 24 hours later. Intravenous N–Acetyl cysteine (NAC) was started immediately after admission. His hospital course included hepatic injury, coagulopathy, acute renal failure and cardiac injury. Cardiac function began to decline on the second hospital day with severe LV systolic dysfunction (EF=10–15%), and pulmonary edema, but began to improve on the 3^rd day. Hepatic injury was mild. Renal injury, consistent with acute tubular necrosis, didn't recover and permanent hemodialysis resulted. A decline in cardiac function may occur following paracetamol overdose.