title: Paracetamol-induced hepatotoxicity at recommended dosage.
abstract: In patients who develop liver damage following moderate paracetamol overdose in the order of 5-10 g daily, recent fasting and nutritional impairment have been identified as key precipitants. Hepatotoxicity caused by paracetamol at recommended dosage, in the absence of exposure to enzyme-inducing drugs, has recently been described as an idiosyncratic phenomenon. The possible importance of fasting and malnutrition in this setting is uncertain. We report a severely malnourished 53-year-old woman who developed severe hepatotoxicity whilst receiving paracetamol at recommended dosage (4 g daily) following a period of fasting, in the absence of enzyme-inducing agents. Subsequent paracetamol exposure up to 2.6 g daily thrice weekly, in the setting of ongoing malnutrition and fasting as before, did not lead to recurrent liver damage. These findings indicate that paracetamol-related liver damage occurring within recommended dosage guidelines can be a dose-dependent rather than necessarily idiosyncratic phenomenon, at least in the setting of recent fasting and severe malnutrition.
authors.affiliation: Gastrointestinal and Liver Unit, The Prince of Wales Hospital and University of New South Wales, Barker Street, Randwick 2031, Sydney, New South Wales, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Kurtovic
authors.forename: S M
authors.initials: SM
authors.lastname: Riordan
mesh_terms: D000082:Acetaminophen / Q000009:adverse effects*; D018712:Analgesics, Non-Narcotic / Q000009:adverse effects*; D001005:Anus Neoplasms / Q000150:complications / Q000532:radiotherapy; D001918:Brachytherapy / Q000379:methods; D002292:Carcinoma, Renal Cell / Q000150:complications / Q000532:radiotherapy; D056486:Chemical and Drug Induced Liver Injury; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000150:complications / Q000532:radiotherapy; D008875:Middle Aged
chemical_list: D018712:Analgesics, Non-Narcotic; D000082:Acetaminophen