Posterior reversible encephalopathy syndrome following iatrogenic acetylcysteine overdose: a case report

Figures & data

Table 1. Laboratory results.

	12 h post-ingestion	27 h post-ingestion	40 h post-ingestion	44 h post-ingestion	66 h post-ingestion	8 days post-ingestion
Laboratory results	Time of admission	After seizures and NAC transiently held	Prior to CRRT	4 h after resumption of NAC
Na, mEq/L	136	144	141	142	148	139
K, mEq/L	3.3	2.2	3.2	3.2	4.0	4.8
Cl, mEq/L	97	93	109	116	118	96
pH	7.38	7.20	7.38		7.40
PCO2, mmHg	33	24	32		32
Bicarbonate, mEq/L	19	8	18	18	20	22
Serum osmolality, mOsm/kg	283	308	286
Glucose, mmol/L (mg/dL)	8.4 (151)	9.8 (176)	6.2 (112)	6.0 (108)	8.5 (153)	6.1 (110)
Creatinine, mmol/L (mg/dL)	55 (0.62)	52 (0.59)	74 (0.84)	65 (0.74)	98 (1.11)	531 (6.01)
AST, U/L	102	350	1012	3517	>7000	58
ALT, U/L	121	401	966	2931	>7000	10
Acetaminophen, umol/L (mg/L)	1393 (210)	420 (63)	236 (36)	151 (23)	<33 (<5)
INR	1.2		2.0	2.8	3.5	1.2
Lactate, mmol/L	2.7	>16.0	2.9		2.0
Salicylates, mmol/L	<0.1
Ammonia, µmol/L (mcg/dL)		52 (88)		77 (131)	120 (204)	23 (39)

AST: aspartate aminotransferase; ALT: alanine aminotransferase; INR: international normalized ratio; CRRT: continuous renal replacement therapy.

Figure 1. Axial T2-weighted-fluid-attenuated inversion recovery (T2/FLAIR) MR (right column) and diffusion-weighted (left column) images demonstrated hyperintensity and diffusion restriction, respectively, within the bilateral medial parietal and occipital lobes at 27-h post-admission.

Figure 2. Axial (left), coronal (Middle), and sagittal (right) T2-weighted-fluid-attenuated inversion recovery (T2/FLAIR) MR images demonstrated hyperintensity within the bilateral medial parietal and occipital lobes at 70-h post-admission.