title: Acute Liver Failure Due to Acetaminophen Poisoning in Patients With Prior Weight Loss Surgery: A Case Series.
abstract: OBJECTIVE
  To identify an association between prior weight loss surgery (WLS) and acetaminophen-induced acute liver failure (ALF).
  
  
  BACKGROUND
  WLS, which has increased in proportion to the global rise of obesity, alters the absorption and metabolism of many drugs including acetaminophen (APAP) and may predispose to toxicity. No study has identified an association between prior WLS and APAP-ALF.
  
  
  METHODS
  We retrospectively reviewed a cohort of patients who presented to our center with ALF. We identified 101 patients who presented to our center with ALF between January 2009 and December 2011. All patients were prospectively enrolled into a database using consensus criteria. A history of WLS was obtained through a retrospective chart review.
  
  
  RESULTS
  Fifty-four patients (53.5%) had APAP-ALF and 47 (46.5%) had ALF caused by other etiologies. A prior history of WLS was present in 9 of the 54 patients with APAP-ALF versus 0 of the 47 with non-APAP-ALF (P=0.003). Patients with APAP-ALF and prior WLS did not have higher rates of factors commonly associated with APAP overdose, including depression, alcohol abuse, intent to cause self-harm, or use of APAP-narcotic combination drugs.
  
  
  CONCLUSIONS
  A history of WLS may predispose to hepatotoxicity and ALF caused by acetaminophen.
authors.affiliation: Department of Transplantation, California Pacific Medical Center, San Francisco, CA.
authors.forename: Edward W
authors.initials: EW
authors.lastname: Holt
authors.forename: Sara
authors.initials: S
authors.lastname: DeMartini
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Davern
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage / Q000506:poisoning*; D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage / Q000506:poisoning; D050110:Bariatric Surgery; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology*; D005260:Female; D006801:Humans; D017114:Liver Failure, Acute / Q000139:chemically induced*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D018712:Analgesics, Non-Narcotic; D000082:Acetaminophen