A 26-year-old woman with a 6-month history of depression accompanied by active suicidal ideation ingests 35 g of acetaminophen. She quickly experiences nausea and vomiting. Within 1 day, she becomes progressively obtunded. On physical examination, her temperature is 36.9deg C, pulse is 75/min, respirations are 15/min, and blood pressure is 100/65 mm Hg. She is treated with N-acetylcysteine. Depletion of which of the following is most likely to accentuate her organ damage?
Acetaminophen toxicity leads to hepatic necrosis, indicated by rising ALT and AST levels. If death is not immediate, hyperbilirubinemia also can be seen. N-Acetylcysteine augments glutathione by contributing a sulfhydryl group for binding to toxic metabolites. Elevated serum amylase is seen in pancreatitis. Elevated serum creatine kinase is seen with injury to skeletal and cardiac muscle. Ketonuria is a feature of absolute insulin deficiency in diabetes mellitus; it also is a feature of starvation. Hypokalemia can be a feature of renal diseases and glucocorticoid deficiency.
Glutathione (GSH)
Amylase
Creatine kinase
Ketone bodies
Environment & Nutritional Pathology