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Background
Deliberate self-harm in the form of paracetamol overdose is extremely common. As well as treating the hepatotoxicity and renal dysfunction effects of the drug, one should be aware that a rare complication of the overdose could be pancreatitis. The abdominal pain from the pancreatitis may be falsely attributed to possible liver or gastric causes. More studies are required to investigate the possible association and the mechanism of pancreatic injury.
Case presentation
A 17-year-old Caucasian woman presented with severe epigastric pain and vomiting 3 h after she had ingested 30x500 mg paracetamol tablets with water. She had no other medical comorbidities and denied taking any regular medication. In the days leading to the overdose, her close friend had died suddenly. She did not smoke, drink alcohol or participate in any recreational drug use including at the time of the overdose.
Investigations
Physical examination was remarkable for epigastric tenderness with guarding. Laboratory studies on admission revealed white cell count of 17.7x109 /litre, neutrophils 15.24x109 /litre, amylase 529 U/litre. Urea, electrolytes, [GAMMA]-glutamyl transpeptidase, calcium and liver function tests were normal. Paracetamol levels were below the treatment line.
An ultrasound did not reveal any calculi within the gallbladder nor biliary dilatation. A CT scan ( fig 1 ) demonstrated acute pancreatitis with free fluid collection between the pancreatic tail and body of the stomach.
Differential diagnosis
Other possible causes of pancreatitis were investigated. The ultrasound excluded gallstones. The patient denied having taken any other drugs, alcohol or any other substances and the toxicology screen was negative. [GAMMA]-Glutamyl transpeptidase was also...