PT  - JOURNAL ARTICLE
AU  - Muzzammil Ali
AU  - Mohammad Misurati
AU  - Rebekah Rodgers
AU  - Jagtar Pooni
TI  - Haemodiafiltration as an effective treatment option for massive paracetamol overdose
AID  - 10.1136/bcr-2018-228920
DP  - 2019 Apr 01
TA  - BMJ Case Reports
PG  - e228920
VI  - 12
IP  - 4
4099  - http://casereports.bmj.com/content/12/4/e228920.short
4100  - http://casereports.bmj.com/content/12/4/e228920.full
SO  - BMJ Case Reports2019 Apr 01; 12
AB  - An 84-year-old woman presented to hospital with severe clinical and metabolic sequelaesequelae of a massive paracetamol overdose (concentration=822 mg/L). In spite of N-acetylcysteine therapy, she deteriorated with evidence of mitochondrial dysfunction. Although the EXtracorporeal TReatments In Poisoning group recommend adjunct haemodialysis (HD) in such a context, this was difficult to start due to haemodynamic instability. Instead, a trial of continuous venovenous haemodiafiltration (CVVHDF) was initiated in an attempt to restore normal mitochondrial function, normal pH and to actively remove the offending drug. Fortunately, plasma paracetamol levels fell exponentially over the subsequent 24–48 hours without the need to commence HD. The patient made a full recovery and was later discharged from the hospital. This case highlights that CVVHDF can be a reasonable alternative to HD for managing massive paracetamol overdoses in the context of mitochondrial dysfunction.