Specimen Name Result Units Range
Plasma Sodium 132 mmol/L (135-145)
Potassium 3.4 mmol/L (3.5-5.5)
Chloride 95 mmol/L (100-109)
Bicarbonate 16 mmol/L (22-32)
Glucose 3.2 mmol/L (3.8-5.5)
Urea 4.0 mmol/L (2.7-7.2)
Creatinine 150 μmol/L (60-110)
Phosphate 1.86 mmol/L (0.80-1.45)
Total Calcium 2.20 mmol/L (2.10-2.55)
Albumin 31 g/L (34-48)
Total Protein 65 g/L (60-80)
Total Bilirubin 56 μmol/L (6-24)
GGT 385 U/L (< 60)
ALP 140 U/L (30-110)
ALT 450 U/L (< 55)
AST 385 U/L (< 45)
LDH 345 U/L (110-230)
CK 156 U/L (< 200)
CK-MB 25 U/L (< 15)
Blood Hb 12 g/L (130-180)
Platelets 132 x109/L (150-450)
WCC 14.5 x109/L (4.0-11.0)
INR 1.8 (0.8-1.2)
APTT 43 Sec. (25-35)
TT 12 Sec. (12-16)
ABG pH 7.32 (7.36-7.44)
PaO2 85 mmHg (70-100)
PaCO2 29 mmHg (35-45)
HCO3- 15 mmol/L (21-26)

30yo male with confusion, drowsiness and jaundice.
Paracetamol-induced Hepatic Necrosis
  • Metabolic acidosis (high AG)
  • Hypoglycaemia
  • High AST, ALT, LDH
  • Low Ca++
  • High INR
  • Other Ix : BAL, [paracetamol]

Clinical Features:

  • nausea & vomiting
  • abdominal pain & tenderness
  • pallor
  • coma - unusual, unless other drugs or late presentation
  • liver dysfunction → *late*, usually ≥ 24 hours
  • → hepatic metabolic pathways
  • of those above "treatment line" and not treated:
    • ≈ 60% → severe liver damage at 3-5 days
    • ≈ 5% → hepatic failure, encepalopathy, coma & death
    • uncommon complications
      • renal failure - ATN ± papillary necrosis
      • cardiac failure
      • pancreatitis