[Acute renal failure after acetaminophen poisoning: report of three cases].
OBJECTIVE
Management of acetaminophen overdose focuses on the risk hepatic failure. However, acute renal failure, although less frequent, can lead to serious metabolic complications and require hemodialysis. We report three cases of acute renal failure related to acetaminophen overdose.


METHODS
Three patients, aged 17-46 yr ingested acetaminophen 19 to 32 g, and were admitted to the intensive care unit because of acute liver failure without hepatic coma. While liver function improved, each patient developed acute renal failure starting on the fourth day. Four sessions of hemodialysis were required in one patient because of anuria. Hepatic function improved from the fourth to the ninth day in each case, whereas renal function recovered later, 10-20 days after ingestion. Investigations were negative for other causes of renal failure, and acute tubular necrosis due to acetaminophen was suspected.


CONCLUSIONS
The pathophysiology of this type of acute tubular necrosis remains unclear and thus, there is no specific treatment. Nevertheless, in all cases of acetaminophen overdose, we suggest following serum creatinine levels during the first week, regardless of the degree hepatic failure or quantity of acetaminophen ingested.
Hengy
Baptiste
B
Département d'anesthésie-réanimation, Pavillon P Réanimation, Hôpital Edouard Herriot, Place d'Arsonval, 69003 Lyon, France. baptiste.hengy@orange.fr
Hayi-Slayman
Davy
D
Page
Mathieu
M
Christin
Françoise
F
Baillon
Jean-Jacques
JJ
Ber
Charles-Eric
CE
Allaouchiche
Bernard
B
Rimmelé
Thomas
T
D000082:Acetaminophen / Q000506:poisoning*; D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000000981:diagnostic imaging; D000293:Adolescent; D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000506:poisoning*; D001002:Anuria / Q000139:chemically induced / Q000628:therapy; D003404:Creatinine / Q000652:urine; D062787:Drug Overdose; D005260:Female; D006801:Humans; D007677:Kidney Function Tests; D007684:Kidney Tubules / Q000473:pathology; D017114:Liver Failure, Acute / Q000139:chemically induced / Q000473:pathology; D008111:Liver Function Tests; D008875:Middle Aged; D009336:Necrosis; D011517:Prothrombin Time; D006435:Renal Dialysis; D014463:Ultrasonography
D018712:Analgesics, Non-Narcotic; D000082:Acetaminophen; D003404:Creatinine