Fatal Acetaminophen Poisoning with Evidence of Subendocardial Necrosis of the Heart
Price, LM
Resident, Department of Pathology, Medical College of Virginia, Richmond, VA.

Poklis, A
Director, Toxicology Laboratory, and associate professor, Department of Pathology, Medical College of Virginia, Richmond, VA.

Johnson, DE
Assistant professor, Department of Pathology, Medical College of Virginia, Richmond, VA.


Abstract
The authors describe a case of fatal acetaminophen overdose which occurred in a 16-year-old female. Her serum acetaminophen concentration 11.5 h postingestion was 154 mg/L. Antidotal therapy was unsuccessful, and after 9 days she died. Autopsy findings included centrilobular zonal liver necrosis, acute proximal renal tubular necrosis, and diffuse alveolar pulmonary damage. Her heart was transplanted into a young woman with congenital heart disease. The recipient expired 14 days after the transplant as a result of sepsis complicating bowel ischemia. The transplanted heart showed extensive subendocardial myocyte necrosis related to acetaminophen toxicity and not rejection.

Keywords:
acetaminophen, acetaminophen poisoning, forensic science, pathology and biology, poisoning, poisonings, subendocardial necrosis

Paper ID: JFS363910930

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Author Price LM, Poklis A, Johnson DE Title Fatal Acetaminophen Poisoning with Evidence of Subendocardial Necrosis of the Heart Symposium , Committee on