title: [Alcohol abuse case of severe liver dysfunction induced by acetaminophen poisoning which was diagnosed as non-hepatic toxicity on admission].
abstract: 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.
authors.affiliation: Department of Critical Care, Tokai University School of Medicine.
authors.forename: Shigeaki
authors.initials: S
authors.lastname: Inoue
authors.forename: Isotoshi
authors.initials: I
authors.lastname: Yamamoto
authors.forename: Kazuki
authors.initials: K
authors.lastname: Akieda
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Sekiguchi
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Otuka
authors.forename: Seiji
authors.initials: S
authors.lastname: Morita
authors.forename: Yoshihide
authors.initials: Y
authors.lastname: Nakagawa
authors.forename: Sadaki
authors.initials: S
authors.lastname: Inokuchi
mesh_terms: 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
chemical_list: D018712:Analgesics, Non-Narcotic; D000082:Acetaminophen; D000111:Acetylcysteine