Acute liver failure after recommended doses of acetaminophen in patients with myopathies.
OBJECTIVE
To determine the likelihood that recommended doses of acetaminophen are associated with acute liver failure in patients with myopathies.


METHODS
Retrospective analysis.


METHODS
Level III pediatric intensive care unit.


METHODS
Two pediatric patients with myopathies and acute liver failure.


METHODS
We determined acetaminophen protein adduct levels, in combination with a literature review and systematic evaluation of the cases, using the Roussel Uclaf Causality Assessment Method for drug-induced liver injury to assess causality between recommended acetaminophen dosing and acute liver failure in two children with myopathies.


RESULTS
The serum adduct levels were consistent with the values previously reported in children with acute liver injury following acetaminophen overdose. We found four similar cases of acute liver failure in pediatric and adult patients with myopathies following recommended acetaminophen doses in the literature (n = 3) and personal communication (n = 1). The Roussel Uclaf Causality Assessment Method suggested a probable relationship between acetaminophen use at recommended doses and acute liver failure in our myopathy patients.


CONCLUSIONS
Our data suggest that some patients with myopathies who are receiving recommended doses of acetaminophen may be at increased risk for the development of toxicity resulting in acute liver failure. More studies are needed to corroborate these findings. In the meantime, we would advise physicians to be alert in these patients while taking acetaminophen, especially when critically ill or postoperative.
Intensive Care and Department of Pediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands.
Ilse
I
Ceelie
Laura P
LP
James
Violette
V
Gijsen
Ron A A
RA
Mathot
Shinya
S
Ito
Coranne D
CD
Tesselaar
Dick
D
Tibboel
Gideon
G
Koren
Saskia N
SN
de Wildt
D000082:Acetaminophen / Q000009:adverse effects*; D000293:Adolescent; D018712:Analgesics, Non-Narcotic / Q000009:adverse effects*; D002648:Child; D005260:Female; D006801:Humans; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data; D017114:Liver Failure, Acute / Q000139:chemically induced* / Q000150:complications; D009135:Muscular Diseases / Q000150:complications*; D009136:Muscular Dystrophies / Q000150:complications; D012189:Retrospective Studies; D014897:Spinal Muscular Atrophies of Childhood / Q000150:complications
D018712:Analgesics, Non-Narcotic; D000082:Acetaminophen
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