Coingestion of cyclooxygenase inhibitors can worsen severe paracetamol poisoning by middle-sized and small arteries vasoconstriction.
OBJECTIVE
We report fatal cases of multifocal ischemic injuries occurring in patients awaiting liver transplantation after severe concomitant paracetamol and cyclooygenase inhibitors self-poisoning.


METHODS
Case report in an intensive care unit.


METHODS
In addition to signs of acute liver failure with a systemic inflammatory response syndrome, these three previously healthy young women demonstrated cutaneous vasoconstriction. One patient displayed a sudden ST-segment elevation with ventricular fibrillation.


METHODS
Angiography, plasma endothelin concentrations measurements, and autopsy.


RESULTS
Radiography showed diffuse vasospasm on mesenteric and renal arteries, transiently reversed by vasodilators. We measured tenfold higher plasma endothelin concentrations than in healthy controls. Autopsy revealed no atherosis (including coronary arteries); organs showed multifocal ischemic injuries without thrombosis.


CONCLUSIONS
Such injuries subsequent to dramatic vasoconstriction suggest that cyclooygenase inhibition has specific deleterious vascular side effects once systemic inflammatory response syndrome is in progress during paracetamol poisoning.
D000082:Acetaminophen / Q000506:poisoning*; D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D018712:Analgesics, Non-Narcotic / Q000506:poisoning*; D000792:Angiography; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000506:poisoning*; D001160:Arterioles; D001219:Aspartate Aminotransferases / Q000097:blood; D016022:Case-Control Studies; D003422:Critical Care / Q000379:methods; D016861:Cyclooxygenase Inhibitors / Q000506:poisoning*; D062787:Drug Overdose; D016232:Endothelins / Q000097:blood; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007511:Ischemia / Q000139:chemically induced / Q000175:diagnosis / Q000378:metabolism / Q000628:therapy; D017114:Liver Failure, Acute / Q000139:chemically induced* / Q000175:diagnosis / Q000378:metabolism / Q000628:therapy; D016031:Liver Transplantation; D008641:Mesenteric Vascular Occlusion / Q000139:chemically induced* / Q000175:diagnosis / Q000378:metabolism / Q000628:therapy; D012078:Renal Artery Obstruction / Q000139:chemically induced* / Q000175:diagnosis / Q000378:metabolism / Q000628:therapy; D012867:Skin / Q000098:blood supply; D018746:Systemic Inflammatory Response Syndrome / Q000139:chemically induced
D018712:Analgesics, Non-Narcotic; D000894:Anti-Inflammatory Agents, Non-Steroidal; D016861:Cyclooxygenase Inhibitors; D016232:Endothelins; D000082:Acetaminophen; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase