#Acetaminophen #overdose. Units are SI, APAP in umol/L. This | Figure 1

JLandyMD

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Acetaminophen overdose. Units are SI, APAP in umol/L. This is at ~3.5h

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Methimazole Case

Methimazole is commonly prescribed for patients with hyperthyroidism. It typically exhibits a well-tolerated profile, with common side effects including gastrointestinal disorders and rash. However, more serious rare yet adverse reactions, notably agranulocytosis and hepatotoxicity have been documented in literature. Here we present a case of a 27-year-old female, recently diagnosed with Graves’ disease, who was prescribed methimazole and developed severe pruritus with cholestatic jaundice 13 days later. Concomitant causes of liver disease were ruled out. The treatment was discontinued, and a switch to corticosteroid therapy with a regimen of radioactive iodine sessions was initiated. The patient’s condition showed a resolution of pruritus and jaundice, a disappearance of cytolysis with an aggravation of cholestasis followed by a gradual decrease, leading to the liver function normalization after 2 years. Methimazole-induced cholestatic jaundice is a rare yet severe adverse effect. Patients should be aware of this complication and advised to immediately stop taking the treatment when suggestive symptoms (pruritus, jaundice, dark urine, light-colored stool) occur.

Other Cases

  1. Continuation to yesterday's boil case. We ran blood work and called the patients to discuss the results. As previously stated, the patient was on #Metronidazole and #Amoxicillin due to a root canal. The patient had a #Cystectomy 20 years ago. I believe the increased LFTs are due to the metronidazole. What are your opinions?

  2. Intentional acetaminophen overdose 2 days prior to presentation at local ER. Complains of general malaise and regret.

  3. A 75-year-old female is brought to the emergency department after ingesting an unknown amount of acetaminophen. Approximately four hours earlier, she was found distraught with empty pill bottles nearby. Her daughter explains her mother was recently diagnosed with dementia, has arthritis, and typically takes extended-release acetaminophen for pain relief throughout the day. After initial assessments, her serum acetaminophen (APAP) concentration is measured revealing a level of 140 mcg/mL. Based on this patient’s history, when would you measure her serum APAP concentration again?

  4. A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis. He had a history of hypertension, long-term smoking, and a sedentary lifestyle. On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.

  5. A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets. Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.

  6. A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.

  7. Patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family, are there any features in this EKG that would warrant further work-up or is this just a pediatric EKG?