Paracetamol Overdose May Cause Transudative Pleural Effusion in Adults

Öz

Paracetamol is the most widely used and prescribed drug word-wide. It is the most common cause of the poisoning and of the fatality due to the toxic administration throughout the world. A 34-year-old female patient applied to our ED with the complaint of swallowing 33 g of paracetamol. After routine toxicity treatment, on the third day of the hospitalization, dyspnea and pain on the right hemithorax and right flank occurred. Chest X-ray showed blunted right sinus. CT revealed bilateral pleural effusion. With thoracentesis, clear, colorless and odor-free fluid of about 500cc was drained. Laboratory examination of the fluid confirmed it as transudate. We believed pleural effusion is related to high-dose paracetamol intake and it occurred due to decrease in pleural permeability and the consequent decrease of the fluid absorption. In conclusion, high-dose intake of paracetamol might cause transudative pleural effusion as a complication.

Anahtar Kelimeler

• paracetamol
• acetaminophen
• over dose
• pleural effusion

Kaynakça

1. 1. David Josephy P. The molecular toxicology of acetaminophen. Drug metabolism reviews. 2005;37(4):581-94.
2. 2. Papazoglu C, Ang JR, Mandel M, Basak P, Jesmajian S. Acetaminophen overdose associated with double serum concentration peaks. Journal of community hospital internal medicine perspectives. 2015;5(6):29589.
3. 3. Duran L, Sisman B, Dogruel C, Yardan T, Baydin A, Yavuz Y. Parasetamol Zehirlenmesinde Intravenöz N-Asetil Sistein Kullanimi/Use of Intravenous N-Acetyl Systein in Paracetamol Intoxication. Journal of Academic Emergency Medicine. 2011;10(4):145.
4. 4. Lancaster EM, Hiatt JR, Zarrinpar A. Acetaminophen hepatotoxicity: an updated review. Archives of toxicology. 2015;89(2):193-9.
5. 5. Mazer M, Perrone J. Acetaminophen-induced nephrotoxicity: pathophysiology, clinical manifestations, and management. Journal of medical toxicology : official journal of the American College of Medical Toxicology. 2008;4(1):2-6.
6. 6. Zarogiannis SG, Kalomenidis I. Can pharmacologic agents speed the rate of resorption of pleural fluid? Current opinion in pulmonary medicine. 2015;21(4):372-5.
7. 7. Porcel JM, Light RW. Diagnostic approach to pleural effusion in adults. Am Fam Physician. 2006;73(7):1211-20.
8. 8. Moschos C, Kalomenidis I. Drug Related Pleural Disease. TTD Plevra Bülteni. 2010;4(3):8-18.

9. 9. Huggins JT, Sahn SA. Drug-induced pleural disease. Clinics in chest medicine. 2004;25(1):141-53.
10. 10. Kossick MA. Intravenous acetaminophen and intravenous ketorolac for management of pediatric surgical pain: a literature review. AANA journal. 2014;82(1):53.
11. 11. Jones VM. Acetaminophen injection: a review of clinical information. Journal of pain & palliative care pharmacotherapy. 2011;25(4):340-9.
12. 12. Lai-Fook SJ. Pleural mechanics and fluid exchange. Physiological reviews. 2004;84(2):385-410.
13. 13. Kouritas VK, Zisis C, Bellenis I, Gourgoulianis KI, Molyvdas PA, Hatzoglou C. Nonsteroidal anti-inflammatory drugs alter the human mesothelial pleural permeability via ion cellular transportation by inhibiting prostaglandin synthesis. Respiration; international review of thoracic diseases. 2012;84(1):62-8.
14. 14. Kouritas VK, Magkouta S, Zisis C, Psallidas I, Gourgoulianis KI, Kalomenidis I. Paracetamol and ibuprofen block hydrothorax absorption in mice. European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. 2015;47(3):426-30; discussion 30.