Seizure after a massive infusion of N-acetylcysteine and successful treatment with a good outcome

N-acetylcysteine is frequently used as an efficacious antidote for acetaminophen toxicity. It prevents liver injury induced by paracetamol and in most cases the overdose of acetylcysteine produces mild clinical effects.

Here we describe a patient who self-treated himself by acetylcysteine after acetaminophen toxicity. Approximately 5 hours after receiving 140 g of acetaminophen, the patient developed confusion, hypotension as well as seizures and also had coagulopathy and acute kidney injury. Other causes of these symptoms were overdose of acetaminophen and amoxicillin. Finally, the patient was treated by extensive supportive therapy and got healed.

This case suggests that massive IV acetylcysteine overdose can cause serious life-threatening conditions. The purpose of reporting this case is to increase the awareness among medical staff concerning adverse reactions revealed after a massive overdose of N-acetylcysteine and their arrangement as well as describing the way of management of such problems. The seizure was one of the manifestations in our case and it is so rare. This indicates that massive dosing of acetylcysteine could form irreversible damages in the brain, so it is very important to start the management as soon as possible and monitor patients precisely.