A 56-year-old female with history of thyroidectomy and chronic back pain presented with abdominal pain, nausea, and vomiting. Her regular medications included thyroxine, paracetamol, and calcitriol supplement. She was admitted to the Alfred Hospital after ingestion of 8 grams of paracetamol on the same day (maximum dose per day = 4 mg). On examination, the patient was conscious with a body temperature of 36^oC (normal range 35.4 – 37.7^oC). Her respiratory was 40 breaths per minute (normal rate: 16 – 20 per minute). Her biochemistry and arterial blood gas results are as follows:
SERUM

ANALYTE	RESULT	REFERENCE INTERVAL
Na	149 mmol/L	135 – 145
K	5.6 mmol/L	3.7 – 5.3
Cl	97 mmol/L	95 – 110
HCO3	15 mmol/L	22 – 32
Urea	9.6 mmol/L	2.5 – 6.6
Creatinine	147 µmol/L	60 – 120
Glucose	5 mmol/L	3.0 – 7.8
Alanine amino transferase (ALT)	90 U/L
Aspartate amino transferase (AST)	88 U/L
?-glutamyl transferase (GGT)	131 U/L

ARTERIAL BLOOD GAS

ANALYTE	RESULT	REFERENCE INTERVAL
pH	7.10	7.32 – 7.43
pCO2	15 mmHg	38 – 54
pO2	29 mmHg	30 – 50
Base excess	-8.6 mmol/L	-2 – 2

• Provide a full interpretation of this case study based on the clinical scenario and laboratory results.(18 points)

• You must propose the possible causes (hypotheses) leading to differential diagnosis and final diagnosis.(24 points)

• Please include an explanation of the aetiology & pathophysiology of disease mechanism.(30 points)

• Your final diagnosis must be strengthened with the suggestion of further laboratory tests and expected results to support the case.(18 points)

Answer rating: 100% (QA)

Interpretation Based on the clinical scenario and laboratory results the patient is likely suffering from paracetamol poisoning Paracetamol is a commo... View the full answer