[A 36-year old schizophrenic patient with paracetamol intoxication].

UNLABELLED: Paracetamol poisoning is by far the most common poisoning. Its diagnosis must be made promptly because it can lead to severe liver damage and even to death. Its management protocol uses N-acetylcysteine which must be administered before the onset of hepatic cytolysis.

OBSERVATION: we report the case of a 36-year old female in a delusional paranoid state admitted to the emergency department with multifocal pains for whom paracetamol poisoning was finally diagnosed. The initial (clinical and biological) results were negative. An unexpectedly severe acute liver failure followed within 48 hours after having been admitted in the hospital. The diagnosis and therefore the administration of the antidote were delayed due to the psychiatric state of the patient which hindered the medical history evaluation.

DISCUSSION: emergency doctors should take extra care when evaluating psychiatric patients since psychiatric symptoms can hinder good medical history taking thereby potentially misguiding the diagnosis and obscuring a potentially lethal disease. Repeated evaluation of these patients is essential.