A Case of Cocaine-Induced Acute Liver Failure Reversed With N-Acetylcysteine

Abstract

Acute liver failure (ALF) is a life-threatening injury that is most often caused by drug-induced injury, including acetaminophen overdose, in the United States. The hallmarks of ALF are hepatic encephalopathy and coagulopathy in a patient without an established history of liver disease. While acetaminophen overdose has an antidote, that is N-acetylcysteine (NAC), when given acutely, most other causes of hepatic failure require an urgent liver transplant. In this paper, we report a case of cocaine-induced acute liver failure that was reversed with the administration of NAC. Our case began when a middle-aged male presented to the emergency department complaining of nausea, vomiting, fatigue, and confusion for the past three days. His past medical history was pertinent for a history of opioid use disorder and his physical exam was remarkable for somnolence, asterixis, and periumbilical ecchymoses. His initial lab results showed markedly elevated liver function tests, prolonged coagulation studies, and a urine drug screen that was positive for cocaine. During the patient’s interview, his vital signs became unstable. He was intubated for airway protection and transferred to a tertiary care facility for liver transplant evaluation with the diagnosis of cocaine-induced acute liver failure. There he received NAC, lactulose, rifaximin, and vasopressors. On day two of treatment, his clinical condition greatly improved, and he was extubated. He continued to receive NAC until day five when his liver function tests and coagulopathy improved enough to stop treatment. This case report highlights the clinical benefit of NAC in a case of cocaine-induced acute liver failure, improving the patient’s survival and eliminating his need for a liver transplant.

Complex Diagnostic Dilemma of Viral Hepatitis vs. Drug-Induced Hepatitis: A Case Report

“…In the differential diagnosis, the possibility of cocaine-induced hepatitis was also considered. Chronic cocaine use has been associated with hepatotoxicity, with features such as elevated liver enzymes and histological changes [7]. However, establishing a direct causal link between cocaine and hepatitis can be challenging, as multiple factors, including concomitant substance abuse, can contribute to liver injury [8].…”

Polysubstance-Induced Hepatotoxicity and the Role of Supportive Management

“…Drug-induced liver injury (DILI) has become an increasingly common condition that affects hepatic metabolism and can progress to liver failure, with accompanying impaired hepatic synthetic function and hepatic encephalopathy [1]. The most common medication to cause acute liver failure is acetaminophen, which accounts for more than 50% of overdose-related cases in the United States [2].…”