Maternal acetaminophen overdose at 15 weeks of gestation

Area of Science:

• Obstetrics and Gynecology
• Clinical Toxicology
• Pharmacology

Background:

• Acetaminophen (N-acetyl-p-aminophenol) is a widely used analgesic and antipyretic agent.
• Its safety profile during pregnancy is generally considered favorable at therapeutic doses.
• High-dose acetaminophen ingestion can lead to severe hepatotoxicity.

Observation:

• A pregnant 32-year-old woman at 15 weeks gestation ingested a massive dose (64 g) of acetaminophen.
• Despite administration of N-acetylcysteine within 24 hours, she developed severe hepatic necrosis.
• Her clinical course was further complicated by adult respiratory distress syndrome.

Findings:

• The patient survived after intensive supportive management.
• She delivered a viable infant via preterm delivery at 32 weeks' gestation.
• The case highlights the potential for severe acetaminophen toxicity even with timely antidote administration.

Implications:

• This case underscores the critical importance of aggressive supportive care in managing massive acetaminophen overdose during pregnancy.
• It prompts further investigation into the mechanisms of acetaminophen toxicity and its potential effects on the fetus.
• Understanding these mechanisms is vital for optimizing treatment strategies and improving maternal-fetal outcomes in overdose scenarios.