[Alcohol abuse case of severe liver dysfunction induced by acetaminophen poisoning which was diagnosed as non-hepatic toxicity on admission].
A 41-year-old female attempted suicide by taking 7.8g acetaminophen and was transferred to our hospital four hours after ingestion. The patient was diagnosed as non-hepatic toxicity (below the line set by the Rumack Matthew nomogram). Laboratory data showed an elevation in serum liver enzymes and coagulation defects at 3 days after ingestion, therefore, the patient was treated with plasma exchange and an oral administration of N-acetylcysteine (NAC). The elevation of liver enzymes was maximal at 4 days after ingestion, and the laboratory data became normalized at approximately 9 days after ingestion. In this case, habitual alcohol intake may have exacerbated the severe liver injury. We should consider an exacerbation of hepatotoxicity and administer NAC in any case having a history of habitual alcohol intake, even if the case was diagnosed as non-hepatic toxicity by the nomogram.
Inoue
Shigeaki
S
Department of Critical Care, Tokai University School of Medicine.
Yamamoto
Isotoshi
I
Akieda
Kazuki
K
Sekiguchi
Hiroshi
H
Otuka
Hiroyuki
H
Morita
Seiji
S
Nakagawa
Yoshihide
Y
Inokuchi
Sadaki
S
D000082:Acetaminophen / Q000506:poisoning*; D000111:Acetylcysteine / Q000008:administration & dosage; D000285:Administration, Rectal; D000328:Adult; D000437:Alcoholism / Q000150:complications*; D018712:Analgesics, Non-Narcotic / Q000506:poisoning*; D062787:Drug Overdose; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000175:diagnosis / Q000209:etiology*; D010951:Plasma Exchange; D012720:Severity of Illness Index; D013406:Suicide, Attempted; D013812:Therapeutics
D018712:Analgesics, Non-Narcotic; D000082:Acetaminophen; D000111:Acetylcysteine