TY - CHAP M1 - Book, Section TI - Drug Biotransformation A1 - Correia, Maria Almira A2 - Katzung, Bertram G. A2 - Vanderah, Todd W. PY - 2021 T2 - Basic & Clinical Pharmacology, 15e AB - CASE STUDYA 40-year-old woman presents to the emergency department of her local hospital somewhat disoriented, complaining of midsternal chest pain, abdominal pain, shaking, and vomiting for 2 days. She admits to having taken a “handful” of Lorcet (hydrocodone/acetaminophen, an opioid/nonopioid analgesic combination), Soma (carisoprodol, a centrally acting muscle relaxant), and Cymbalta (duloxetine HCl, an antidepressant/antifibromyalgia agent) 2 days earlier. On physical examination, the sclera of her eyes shows yellow discoloration. Laboratory analyses of blood drawn within an hour of her admission reveal abnormal liver function as indicated by the increased indices: alkaline phosphatase 302 (41–133),* alanine aminotransferase (ALT) 351 (7–56),* aspartate aminotransferase (AST) 1045 (0–35),* bilirubin 3.33 mg/dL (0.1–1.2),* and prothrombin time of 19.8 seconds (11–15).* In addition, plasma bicarbonate is reduced, and she has ∼45% reduced glomerular filtration rate from the normal value at her age, elevated serum creatinine and blood urea nitrogen, markedly reduced blood glucose of 35 mg/dL, and a plasma acetaminophen concentration of 75 mcg/mL (10–20).* Her serum titer is significantly positive for hepatitis C virus (HCV). Given these data, how would you proceed with the management of this case?*Normal values are in parentheses. SN - PB - McGraw-Hill CY - New York, NY Y2 - 2024/03/28 UR - accessmedicine.mhmedical.com/content.aspx?aid=1176461610 ER -