Intravenous acetaminophen associated with acute liver failure

Q4 Medicine
Maunoo Lee, Joshua McCarron, Aaron Balinski, Richard Bower
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Abstract

In conjunction with BMJ Case Reports, DTB will feature occasional drug-related cases that are likely to be of interest to readers. These will include cases that involve recently marketed drugs for which there is limited knowledge of adverse effects and cases that highlight unusual reactions to drugs that have been marketed for several years. A woman in her mid-60s, without known liver disease, was admitted to the hospital with a partial malignant colonic obstruction. Over a 6-day course, she received a total of 13 g of intravenous acetaminophen not exceeding 4 g over a 24-hour period. She developed encephalopathy and an international normalised ratio of 6.1 meeting criteria for acute liver failure (ALF). She was treated with intravenous N-acetyl cysteine and other causes of liver failure were excluded. The patient was discharged with subsequent resolution of encephalopathy and improvement of her liver chemistries. Though ALF is rare, in countries where acetaminophen is readily available, almost 50% of ALF cases are acetaminophen-induced hepatotoxicity and most have been documented as oral ingestion of acetaminophen. We present a rare case of intravenous acetaminophen-induced ALF. Acute liver failure (ALF) is defined as new onset coagulopathy with international normalised ratio (INR) ≥1.5 and encephalopathy without pre-existing cirrhosis.1 Drug-induced liver injury (DILI) is the most common cause of ALF in the USA occurring at a rate of 20 cases per 100 000 persons.2 3 Of all DILI cases, acetaminophen-induced hepatotoxicity accounts for up to 46% of ALF cases.2 The two main aetiologies of acetaminophen overdoses are either intentional, often in context of suicide attempts, and unintentional overdoses, also known as therapeutic misadventures.3 4 Bower et al conducted a population-based surveillance for ALF that noted 55% of all acetaminophen-related ALF cases to be therapeutic misadventures.5 Current US Food and Drug Administration packaging …
静脉注射对乙酰氨基酚导致急性肝衰竭
DTB 将与 BMJ 病例报告合作,不定期刊登读者可能感兴趣的药物相关病例。这些病例包括近期上市的药物(对其不良反应了解有限),以及已上市数年的药物的异常反应。一位 60 多岁的妇女因部分恶性结肠梗阻入院,她没有已知的肝病。在为期 6 天的治疗过程中,她总共静脉注射了 13 克对乙酰氨基酚,24 小时内用药量不超过 4 克。她出现了脑病,国际正常化比率为 6.1,符合急性肝衰竭 (ALF) 的标准。她接受了 N-乙酰半胱氨酸静脉注射治疗,并排除了导致肝衰竭的其他原因。患者出院后,脑病得到缓解,肝脏化学指标也有所改善。虽然ALF很罕见,但在对乙酰氨基酚很容易买到的国家,几乎50%的ALF病例都是对乙酰氨基酚引起的肝中毒,而且大多数病例都有口服对乙酰氨基酚的记录。我们介绍了一例罕见的静脉注射对乙酰氨基酚诱发的 ALF 病例。急性肝衰竭(ALF)是指国际正常化比值(INR)≥1.5 的新发凝血病和无肝硬化的脑病。对乙酰氨基酚过量的两种主要病因是故意过量(通常是企图自杀)和非故意过量(也称为治疗失误)。3 4 Bower 等人对 ALF 进行了一项基于人群的监测,结果发现在所有与对乙酰氨基酚相关的 ALF 病例中,55% 属于治疗失误。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Drug and Therapeutics Bulletin
Drug and Therapeutics Bulletin Medicine-Pharmacology (medical)
CiteScore
0.80
自引率
0.00%
发文量
69
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