Advanced Medical Life Support (AMLS)

What toxin overdose is suspected in a patient with abdominal pain, nausea, vomiting, and a blood glucose of 42 after taking prescribed and OTC analgesics?

1. Amphetamine

2. Acetaminophen

3. Barbiturate

4. Benzodiazepine

The correct answer is: Acetaminophen

The symptoms of abdominal pain, nausea, vomiting, and a significantly low blood glucose level of 42 strongly suggest a potential acetaminophen overdose. Acetaminophen is commonly found in both prescribed and over-the-counter analgesics, making it a likely suspect in this scenario. In acetaminophen toxicity, the initial gastrointestinal symptoms such as nausea and vomiting are often the first to manifest. The subsequent lethargy or altered mental status can lead to a decreased level of consciousness, potentially impacting the individual's ability to maintain adequate blood glucose levels due to decreased hepatic function and metabolic disturbances resulting from liver injury. Furthermore, acetaminophen is metabolized in the liver, and an overdose can lead to the production of toxic metabolites that cause hepatocellular damage. This damage can exacerbate metabolic derangements, including hypoglycemia, as the liver plays a key role in gluconeogenesis. Given these factors, the overall clinical picture aligns well with acetaminophen toxicity, both in terms of the substance commonly misused or ingested beyond the therapeutic range and the specific combination of gastrointestinal symptoms alongside hypoglycemia. This makes acetaminophen the most appropriate choice in this scenario.