You are here

Article Text

Article menu
Download PDFPDF
Republished case report
Intravenous acetaminophen associated with acute liver failure
  1. Maunoo Lee1,
  2. Joshua McCarron2,
  3. Aaron Balinski3,
  4. Richard Bower1
  1. 1 Department of Gastroenterology, Naval Medical Center San Diego, San Diego, California, USA
  2. 2 Department of Gastroenterology, 99th Medical Group Mike O'Callaghan Military Medical Center, Nellis AFB, Nevada, USA
  3. 3 Department of Internal Medicine, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
  1. Correspondence to Dr Maunoo Lee; maunoolee{at}gmail.com

https://doi.org/10.1136/dtb.2024.251305rep

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    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.

    Summary

    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.

    Background

    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 …

    View Full Text

    Footnotes

    • Contributors ML wrote the manuscript and reviewed the literature. AB reviewed the literature and edited the figures. JM edited the manuscript and reviewed the literature. RB edited the manuscript and is the author guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.