Anaphylactic shock complicated with multiple organ dysfunction syndrome caused by compound paracetamol tablet

Abstract

A 48-year-old woman took 2 tablets of compound paracetamol tablet for headache. Her headache was relieved. She took 2 tables of compound paracetamol tablet again on the next day because of headache once again. Twenty minutes after drug administration, she developed dizziness, fatigue. Then scattered rash appeared on her face, neck and arms. Her blood pressure was 80/50 mmHg with heart rate 102 beats/min. The patient received a speedy IV infusion of hydroxyethyl starch 500 ml, intravenous injection of dexamethasone 10 mg and calcium gluconate 10 ml, and an IV infusion of vitamin C 3.0 g dissolved in 205 ml sodium chloride. Laboratory test showed slightly declined platelets, increased urea nitrogen, obviously increased levels of blood serum total bilirubin, direct bilirubin, alanine aminotrans-ferase, and aspartate transaminase, slightly increased troponin-T, troponin-I, and creatine kinase MB isoenzyme, obviously prolonged prothrombin time and activated partial thromboplastin time, and the markedly reduced prothrombin activity and fibrinogen. The patient was diagnosed as anaphylactic shock complicated with multiple organ dysfunction syndrome caused by compound paracetamol tablet. Compound paracetamol tablet was stopped. She received the symptomatic treatments of antianaphylaxis, protecting heart, liver and kidney. Fifteen days later, her erythra disappeared, liver and kidney function, myocardial enzymes, and blood coagulation index returned to normal. Key words: Acetaminophen; Anaphylaxis; Multiple organ failure