12 August 2025
: Case report 
N-Acetylcysteine and Hemodialysis in Severe Acetaminophen Toxicity in a 15-Year-Old Adolescent: A Case Report
Unusual clinical course, Unusual or unexpected effect of treatment
Phillip D. Cohen
BCDEF 1*, Brian R.E. Schultz CDEF 2, Jennifer Schuette CDEF 1, Sapna R. Kudchadkar CDEF 1,2
DOI: 10.12659/AJCR.948715
Am J Case Rep 2025; 26:e948715
Table 1 Patient laboratory data throughout the inpatient course.
| Time since ingestion | |||||||
|---|---|---|---|---|---|---|---|
| 4 hA(Admission) | 20 hB(Before 1st HD) | 30 hC(After 1st HD) | 42 hD(After hospital transfer) | 68 hE(Before 2nd HD) | 96 hF(After 2nd HD) | 110 hG(Medically cleared) | |
| Acetaminophen Level (ref 10-30 mg/L) | 272 | >400 | 253 | 193 | 347 | 6 | <5 |
| ALT (ref ≤40 U/L) | 26 | 27 | 46 | 68 | 5138 | 5454 | 4226 |
| AST (ref ≤37 U/L) | 30 | 21 | 36 | 34 | 3595 | 2218 | 839 |
| INR (ref 0.9–1.1) | 1.1 | 1.3 | 1.9 | 1.8 | 2.9 | 1.8 | 1.3 |
| Glucose (ref 60–100 mg/dL) | 166 | 165 | 105 | 117 | 130 | 113 | 184 |
| Lactate (ref 0–2.2 mmol/L) | 1.8 | 8.5 | 1.0 | 1.4 | 3.0 | 1.0 | 2.1 |
| HCO3 (ref 21–31 mmol/l) | 21 | 8 | 23 | 19 | 17 | 24 | 23 |
| TBili (ref ≤1.2 mg/dL) | 0.7 | 1.8 | 2.7 | 2.7 | 1.5 | 1.5 | 1.8 |
| Cr (ref 0.6–1.3 mg/dL) | 0.3 | 0.2 | 0.2 | 0.5 | 0.2 | 0.3 | 0.5 |
| Albumin (ref 3.5–5.3 g/dL) | 4.1 | 3.2 | 3.3 | 3.5 | 3.0 | 3.4 | 3.6 |
| Ammonia (ref ≤32 mcmol/L) | -- | <9 | 27 | 30 | 56 | -- | 48 |
| Ref – laboratory reference range; ALT – alanine aminotransferase; AST – aspartate aminotransferase; INR – international normalized ratio; HCO3 – bicarbonate; Tbili – total bilirubin; Cr – creatinine; HD – hemodialysis; NAC – N-acetylcysteine. | |||||||