Publisher's copyright statement: NOTICE: this is the author's version of a work that was accepted for publication in Gastroenterology. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reected in this document. Changes may have been made to this work since it was submitted for publication. A denitive version was subsequently published in Gastroenterology, 143/3, 2012Gastroenterology, 143/3, , 10.1053Gastroenterology, 143/3, /j.gastro.2012 Additional information:
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Antioxidant Therapy does not reduce pain in patients with ChronicPancreatitis: The ANTICIPATE study.
We studied the relationship between alcohol consumption and hepatotoxicity related to paracetamol ingestion both in cases of overdose with suicidal intent and in cases where paracetamol was apparently taken for therapeutic reasons. In a retrospective study of 553 patients admitted to a specialist liver unit between January 1987 and December 1993 with paracetamol-induced hepatotoxicity, there was no difference in the severity of the hepatotoxicity following either a deliberate or an inadvertent overdose. Heavy alcohol consumption was more common in males than females and more commonly associated with deliberate overdoses of >15 g. There was no correlation between alcohol consumption and severity of hepatotoxicity (mean INR and the serum creatinine levels over the first 7 days after the overdose). The significantly lower platelet count in heavy drinkers was probably the consequence of direct alcohol toxicity to the marrow. Overall there was a greater incidence of heavy alcohol consumption amongst therapeutic misadventure compared to deliberate overdose cases, but there was no difference between the two groups when amounts of <10 g/day were involved. Eleven (29%) patients in the therapeutic misadventure group were depressed, 10 of whom had previously attempted suicide. In conclusion, we were unable to demonstrate that heavy drinkers develop more severe hepatotoxicity following paracetamol overdose than non-drinkers, and from the material reported in this study, accidental overdose is a better defining term than therapeutic misadventure.
Hydroxychloroquine is widely used in rheumatological disease but hepatic side effects have not been reported previously. Two cases are described of fulminant hepatic failure developing after the start of hydroxychloroquine treatment for a chronic rheumatological disorder. In both cases the symptoms of liver disease developed within two weeks of starting hydroxychloroquine and rapidly progressed to fulminant hepatic failure and in neither case was there any pre-existing liver disease. One patient had emergency orthotopic liver transplantation and the other died before a donor organ became available.
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