Liver damage after paracetamol overdose. Comparison of liver-function tests, fasting serum bile acids, and liver histology.
54 patients have been studied after paracetamol (acetaminophen) overdose. Liver-function tests and fasting serum bile-acids were measured daily; liver biopsy was done in all cases, and slides were examined "blind" to assess liver damage. The plasma-paracetamol was measured on one occasion. A histological abnormality was present in the livers of 53 of the 54 patients, and was minor in 23, moderate in 16, and severe in 14. In 6 patients with moderate and 18 with mild histological abnormality liver-function tests were normal. A serum-aspartate-aminotransferase above 400 units/1 was always associated with severe histological liver damage. Fasting serum bile-acids were raised in 51 of the patients with abnormal liver histology; the serum-bile-acid seemed to be a more sensitive indicator of mild liver-cell damage than was the transaminase level. There was, however, little correlation between increase in bile-acid concentration and the degree of histological abnormality. As a result of these investigations empirically determined levels of plasma-paracetamol have been drawn which give a guide to the likelihood of liver damage after paracetamol overdose.
D000082:Acetaminophen / Q000009:adverse effects*; D000293:Adolescent; D000328:Adult; D001647:Bile Acids and Salts / Q000097:blood*; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D003543:Cysteamine / Q000627:therapeutic use; D006801:Humans; D008099:Liver / Q000187:drug effects* / Q000473:pathology; D008111:Liver Function Tests; D008875:Middle Aged; D010288:Parenteral Nutrition
D001647:Bile Acids and Salts; D000082:Acetaminophen; D003543:Cysteamine