title: [Severe toxic acute liver failure: etiology and treatment].
abstract: Many substances, drugs or not, can be responsible for acute hepatitis. Nevertheless, toxic etiology, except when that is obvious like in acetaminophen overdose, is a diagnosis of elimination. Major causes, in particular viral etiologies, must be ruled out. Acetaminophen, antibiotics, antiepileptics and antituberculous drugs are the first causes of drug-induced liver injury. Severity assessment of the acute hepatitis is critical. Acute liver failure (ALF) is defined by the factor V, respectively more than 50% for the mild ALF and less than 50% for the severe ALF. Neurological examination must be extensive to the search for encephalopathy signs. According to the French classification, fulminant hepatitis is defined by the presence of an encephalopathy in the two first weeks and subfulminant between the second and 12th week after the advent of the jaundice. During acetaminophen overdose, with or without hepatitis or ALF, intravenous N-acetylcysteine must be administered as soon as possible. In the non-acetaminophen related ALF, N-acetylcysteine improves transplantation-free survival. Referral and assessment in a liver transplantation unit should be discussed as soon as possible.
authors.affiliation: Service d'anesthésie et des réanimations, réanimation chirurgicale hépatobiliaire, digestive et transplantation, université Paris-12, CHU Henri-Mondor, 51, avenue de Lattre-de-Tassigny, 94000 Créteil, France. roland.amathieu@hmn.aphp.fr
authors.forename: R
authors.initials: R
authors.lastname: Amathieu
authors.forename: E
authors.initials: E
authors.lastname: Levesque
authors.forename: J-C
authors.initials: JC
authors.lastname: Merle
authors.forename: M
authors.initials: M
authors.lastname: Chemit
authors.forename: C
authors.initials: C
authors.lastname: Costentin
authors.forename: P
authors.initials: P
authors.lastname: Compagnon
authors.forename: G
authors.initials: G
authors.lastname: Dhonneur
mesh_terms: D000082:Acetaminophen / Q000009:adverse effects; D000111:Acetylcysteine / Q000008:administration & dosage / Q000627:therapeutic use; D058186:Acute Kidney Injury / Q000209:etiology / Q000628:therapy; D000890:Anti-Infective Agents / Q000009:adverse effects / Q000627:therapeutic use; D001778:Blood Coagulation Disorders / Q000188:drug therapy / Q000209:etiology; D056486:Chemical and Drug Induced Liver Injury / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery / Q000628:therapy*; D002779:Cholestasis / Q000175:diagnosis; D003131:Combined Modality Therapy; D003937:Diagnosis, Differential; D019468:Disease Management; D006501:Hepatic Encephalopathy / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D006525:Hepatitis, Viral, Human / Q000175:diagnosis; D006801:Humans; D013287:Illicit Drugs / Q000009:adverse effects; D017114:Liver Failure, Acute / Q000139:chemically induced* / Q000188:drug therapy / Q000628:therapy*; D008111:Liver Function Tests; D016031:Liver Transplantation; D009145:Mushroom Poisoning / Q000175:diagnosis; D009460:Neurologic Examination; D009784:Occupational Diseases / Q000139:chemically induced / Q000628:therapy; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy; D018805:Sepsis / Q000188:drug therapy / Q000209:etiology; D012769:Shock / Q000209:etiology / Q000628:therapy; D013997:Time Factors; D014635:Valproic Acid / Q000009:adverse effects
chemical_list: D000890:Anti-Infective Agents; D013287:Illicit Drugs; D000082:Acetaminophen; D014635:Valproic Acid; D000111:Acetylcysteine