At the time of admission, she had an acetylcysteine infusion of 67 mL/hr without documentation of the dose or concentration.

Upon arrival, her aspartate transaminase (AST) and alanine transaminase (ALT) levels were 9,388 and 7,472 IU/L, international normalized ratio (INR) was 4.1, and lactate level was 3.4 mmol/L. Over the next 2 days, her transaminase levels rose dramatically and her synthetic function rapidly declined she was then transferred to a tertiary care facility for a liver transplant evaluation. At 4 pm, her serum acetaminophen concentration was 24.2 mcg/mL, raising concern that she had ingested more than the reported dose. She presented to an outside hospital at 10 am with complaints of epigastric pain, nausea, and vomiting, and was started on an acetylcysteine infusion in the emergency department. In 2010, a 20-year-old black woman ingested ten 500-mg acetaminophen tablets in a reported suicide attempt at 4 am. Acetylcysteine is the established antidote for acetaminophen toxicity however, its overdose is associated with several adverse effects.

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