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Delayed Toxicity in an Isolated Extended-Release Acetaminophen Ingestion: A Case Report

Brannon L Inman*, Lloyd Tannenbaum, Joseph K Maddry, Sarah Bridsong

Acetaminophen is a common toxic ingestion and the leading cause of acute liver failure in the United States. There exists a relative paucity of evidence in guiding management of acetaminophen Extended-Release ingestions compared to immediate-release ingestions. Many case reports involving Extended-Release acetaminophen ingestion are confounded by co-ingestion, resulting in a delayed peak acetaminophen level. Few reports have been published involving pure acetaminophen Extended-Release ingestion with a late crossing of the Rumack-Matthew nomogram. We present a case of witnessed isolated acetaminophen Extended-Release ingestion in an 18-year-old male, resulting in an acetaminophen level crossing the Rumack-Matthew nomogram treatment threshold at 21 hours post-ingestion.