Acute renal failure after acetaminophen overdose: report of two cases

Two cases of acute tubular necrosis without hepatic failure following acetaminophen overdose are reported. A 19-year-old Caucasian woman ingested 100 500-mg capsules of acetaminophen. She was admitted to a hospital 68 hours after ingestion, and serum acetaminophen concentration 70 hours after ingestion was 3 microgram/ml. Liver-function test results were markedly elevated, and urinalysis was abnormal on admission. Liver function improved over the next five days, but the patient's renal function deteriorated. Her condition initially was diagnosed as prerenal azotemia, but was later consistent with acute tubular necrosis. Hemodialysis was begun on the fifth day of hospitalization. On the eleventh hospital day, the patient's renal function began to improve, and she was subsequently discharged. In the second case, a 19-year-old Spanish-American woman ingested 30 500-mg capsules of acetaminophen. She was seen in an emergency room 16 hours after the ingestion; her serum acetaminophen concentration was 32 microgram/ml 19 hours after ingestion. Oral acetylcysteine therapy was begun, and liver-function test results were elevated and peaked on the third hospital day. Renal function began to decline on the fifth hospital day; her condition was consistent with acute tubular necrosis. She was hemodialyzed once, and her renal function improved on the tenth hospital day. She was subsequently discharged. It is concluded that acute renal failure without prior hepatic failure may occur after acetaminophen overdose.