Death in an adolescent following an overdose of acetaminophen and phenobarbital
J. T. Wilson, V. Kasantikul, R. Harbison and D. Martin
A 13-year-old epileptic girl took an overdose of acetaminophen (Tylenol)
and phenobarbital. Hepatic encephalopathy developed and the patient died
eight days later. Necropsy revealed extensive centrilobular necrosis of the
liver, degeneration of the renal distal tubules, and infarcted and
demyelinated foci throughout the white matter of the cerebral cortex.
Electron microscopy of intact hepatocytes showed a proliferation of both
smooth and rough endoplasmic reticulum consistent with enzyme induction
from phenobarbital. To our knowledge, this is the first reported death in a
child in the United States as a result of acetaminophen and should alert
physicians to an expected increase in acetaminophen toxicity as the drug
becomes more widely available.
