MS 1 looking for an answer

[corona 247]

Not sure if this is right place to post but....

Trying to find info regarding BUN changes in a pt who Overdoses on acetaminophen. I have seen data saying that the BUN would be elevated, and another data source say that it would be depressed. Is the answer then, 'It depends"?

The only info given to me is that the pt has OD on '30-40' Tylenol, and I need to know what would happen to the BUN levels.

I appreciate any feedback and/or places of reference!

Thanks

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[TysonCook]

Off the top of my head...
Acetaminophen Tox = Hepatic Tox = eventually liver failure (in 5%). Decreased functioning of the liver = decreased formation of hepatic urea = <BUN.

give or take a lot more pathophys. you may want to throw this over to the IM guys 'cause EM guys would get bored at this point

Just a guess...

 

[Chartres]

Ingestion of > 7g is considered potentially toxic. The toxic effects of acetaminophen are due to the metabolites produced when the glucuronidation pathway is saturated. That's why acetylcysteine is given as an antidote: it binds the toxic metabolite.

Anyway, the damage isn't immediately apparent (1-2 days for liver damage to show up) and the renal failure, which doesn't occur in every patient, is usually related to the hepatoxicity. (Although there's some interesting data about renal failure in absence of hepatoxicity.)

This could be why you read differing data on BUN levels. I'm sure there's someone who's doing a toxicology fellowship out there who could provide better/more information...