Improved outcome of paracetamol-induced fulminant hepatic failure by late administration of acetylcysteine.
The influence of acetylcysteine, administered at presentation to hospital, on the subsequent clinical course of 100 patients who developed paracetamol-induced fulminant hepatic failure was analysed retrospectively. Mortality was 37% in patients who received acetylcysteine 10-36 h after the overdose, compared with 58% in patients not given the antidote. In patients given acetylcysteine, progression to grade III/IV coma was significantly less common than in those who did not receive the antidote (51% vs 75%), although the median peak prothrombin time was similar for both groups. Whether the beneficial effect is related to replenishment of glutathione stores or a consequence of another hepatic protective mechanism of acetylcysteine requires further study.
Harrison
P M
PM
Liver Unit, King's College Hospital and School of Medicine and Dentistry, London, UK.
Keays
R
R
Bray
G P
GP
Alexander
G J
GJ
Williams
R
R
D000082:Acetaminophen / Q000506:poisoning*; D000111:Acetylcysteine / Q000008:administration & dosage / Q000627:therapeutic use*; D000208:Acute Disease; D000328:Adult; D001219:Aspartate Aminotransferases / Q000097:blood; D004341:Drug Evaluation; D005260:Female; D006501:Hepatic Encephalopathy / Q000097:blood / Q000139:chemically induced* / Q000188:drug therapy / Q000401:mortality; D006801:Humans; D007262:Infusions, Intravenous; D008099:Liver / Q000473:pathology; D008297:Male; D009336:Necrosis; D011379:Prognosis; D011517:Prothrombin Time; D012189:Retrospective Studies; D013997:Time Factors
D000082:Acetaminophen; D001219:Aspartate Aminotransferases; D000111:Acetylcysteine