Acute liver failure in two patients with regular alcohol consumption ingesting paracetamol at therapeutic dosage.
BACKGROUND
The possible role of alcohol in the development of hepatotoxicity associated with therapeutic doses of paracetamol (acetaminophen) is currently debated.


METHODS
We describe 2 patients who were regular consumers of alcohol and who developed liver failure within 3-5 days after hospitalization and stopping alcohol consumption while being treated with 4 g paracetamol/day. A paracetamol serum level obtained in one of these patients was not in the toxic range. Possible risk factors for the development of hepatotoxicity in patients treated with therapeutic doses of paracetamol are discussed.


CONCLUSIONS
In patients with risk factors, e.g. regular consumption of alcohol, liver failure is possible when therapeutic doses are ingested. We propose that the paracetamol dose should not exceed 2 g/day in such patients and that their liver function should be monitored closely while being treated with paracetamol.
Krähenbuhl
Stephan
S
Division of Clinical Pharmacology and Toxicology, University Hospital Basel, Basel, Switzerland. kraehenbuehl@uhbs.ch
Brauchli
Yolanda
Y
Kummer
Oliver
O
Bodmer
Michael
M
Trendelenburg
Marten
M
Drewe
Jurgen
J
Haschke
Manuel
M
D000082:Acetaminophen / Q000009:adverse effects*; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking; D018712:Analgesics, Non-Narcotic / Q000009:adverse effects*; D005260:Female; D006801:Humans; D017114:Liver Failure, Acute / Q000139:chemically induced*; D008297:Male
D018712:Analgesics, Non-Narcotic; D000082:Acetaminophen