[Liver albumin dialysis--application in acetaminophen poisoning].
Acetaminophen is found to be potentially hepatotoxic drug. Both, acute acetaminophen intoxication (dose >10 g) and therapeutic dose administration in the case of glutathion depletion (chronic alcohol abuse) hepatotoxic effect may occur. Late N-acetylcysteine (NAC) administration does not prevent liver injury. Molecular Adsorbents Recirculating System (MARS) is useful liver support device based on albumin dialysis for saving time for spontaneous liver regeneration or bridging technique to liver transplantation.


METHODS
Two cases admitted to the Department in 19 and 20 hour post-ingestion of hepatotoxic paracetamol doses as confirmed by toxiocological examination (serum paracetamol concentration). Despite of NAC administration the signs of the liver injury (progressive encephalopathy and jaundice, decreased prothrombin activity) developed. On day four post exposure according to King's College of Medicine London criteria both cases were qualified to MARS therapy. Albumin dialysis of 8 hour duration was performed in both cases and a full recovery with normalization of the liver function was noted. Patient three: patient with the liver and the kidney insufficiency due to alcohol-paracetamol syndrome admitted to the Department of Clinical Toxicology for MARS therapy. Five performed dialysis resulted in the liver function improvement. The patient was disqualified from the liver transplant because of heart failure, pneumonia, hyperthyroidism and alcoholism. Patient died because of heart failure.
Hydzik
Piotr
P
Klinika Toksykologii KMPiChS, Collegium Medicum, Uniwersytetu Jagiellońskiego w Krakowie. piodzik@poczta.onet.pl
Drozdz
Maciej
M
Sułowicz
Wadysław
W
Groszek
Barbara
B
D000082:Acetaminophen / Q000097:blood / Q000506:poisoning*; D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000097:blood / Q000506:poisoning; D062787:Drug Overdose; D005260:Female; D006501:Hepatic Encephalopathy / Q000139:chemically induced / Q000628:therapy*; D006801:Humans; D017114:Liver Failure, Acute / Q000139:chemically induced / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000379:methods; D012709:Serum Albumin / Q000378:metabolism*; D016896:Treatment Outcome
D018712:Analgesics, Non-Narcotic; D012709:Serum Albumin; D000082:Acetaminophen