Acetaminophen Overdose with Fetal Demise

Haibach, Helmut; Akhter, Jeanette E.; Muscato, Mary S.; Cary, Paul; Hoffmann, Mark

doi:10.1093/ajcp/82.2.240

Cited by 39 publications

(9 citation statements)

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“…Horowitz et al comment on the normal recovery of two women who ingested "repetitive, supratherapeutic (>4 g/day) doses" of APAP [5]. Haibach et al reported on a 24-year-old at 27-28 weeks EGA who ingested 29 g of APAP over less than 24 h resulting in hepatotoxicity, fetal demise and eventual maternal recovery with NAC therapy [6]. Stokes et al reported on a 17-year-old at 21 weeks EGA who ingested 25 g of paracetamol in two doses of 10 and 15 g, 18 and 8 h before admission who developed hepatotoxicity but recovered with NAC therapy to have a normal pregnancy [7].…”

Section: Discussionmentioning

confidence: 99%

Unintentional Chronic Acetaminophen Poisoning During Pregnancy Resulting in Liver Transplantation

Thornton

Minns

2012

J. Med. Toxicol.

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Introduction Acetaminophen (APAP) is a widely used medication in pregnancy and is considered safe. Unfortunately, APAP is also among the most commonly reported agents implicated in overdoses during pregnancy. We present a unique case of a pregnant patient with fulminant hepatic failure resulting in a liver transplant from repeated supratherapeutic ingestions of APAP. Case Report A 22 year pregnant female presented with abdominal pain and hepatotoxicity after taking supratherapeutic amounts of APAP to treat dental pain. The patient denied intentional or acute ingestion of APAP but did admit to taking approximately 8-9 grams of APAP per day for 10-14 days for dental pain. Other cause of hepatotoxicity, including acute fatty liver of pregnancy, were evaluated for and ruled out. She developed fulminant hepatic failure and required liver transplantation which was successful. The pregnancy remained viable through the operation but intrauterine fetal demise occurred 2 weeks later. An MRI of the fetus showed extensive peri-cerebral and intraventricular hemorrhage with extensive periventricular leukomalacia. Discussion The degree of morbidity from repeated supratherapeutic ingestions of APAP seen in this case is rare and poorly described in a pregnant patient. There are no prior reports describing the need for liver transplant after repeated supratherapeutic ingestions of APAP during pregnancy. Along with the typical cause of hepatotoxicy several unique pregnancy-related causes also had to be evaluated for. This case highlights the significant morbidity that can occur with even unintentional APAP toxicity and the need to educate patients, especially pregnant patients, of the risk of excessive APAP use.

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Section: Discussionmentioning

confidence: 99%

Unintentional Chronic Acetaminophen Poisoning During Pregnancy Resulting in Liver Transplantation

Thornton

Minns

2012

J. Med. Toxicol.

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“…Secondly, the potential for acetaminophen toxicity in pregnancy may cause fetal deaths. Although rare, fetal deaths due to acetaminophen toxicity may arise from the inability of NAC to cross the placenta 28,29 . In such instances, 4-MP may play an adjunctive role.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Therapeutic Efficacy of 4-Methylpyrazole andN-Acetylcysteine on Acetaminophen (Paracetamol) Hepatotoxicity in Rats

Küçükardalı

Cinan

Acar

et al. 2002

Current Medical Research and Opinion

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Obtaining effective analgesia with a minimal erosive effect on gastric mucosal tissue has increased the consumption of acetaminophen (paracetamol), especially among the elderly. However, the hepatotoxic effects of acetaminophen have also increased. We aimed to compare the effects of 4-methylpyrazole (4-MP), N-acetylcysteine (NAC) and their combined use on the hepatotoxicity of acetaminophen in a rat model. Male Wistar Albino rats were divided into six groups. Groups 1-5 received 2,000 mg/kg acetaminophen by gavage while the control group was group 6. Group 2 animals were given NAC (loading dose 140 mg/kg followed by seven doses at 4 h intervals); group 3 received 50 mg/kg 4-MP; group 4 received 200mg/kg 4-MP; and group 5 received NAC as in group 2 plus 200 mg/kg 4-MP. Blood samples were taken for measurements of serum AST and ALT levels. The livers of the rats were removed for microscopic examination and grading of hepatic necrosis. AST and ALT levels in groups 2-5 were lower than that of group 1 (p < 0.001), although no significant difference was noted between groups 2-5 (p > 0.05). Higher levels of ALT were found in group 5 than in group 2 (p < 0.05), and higher levels of AST were found in group 5 than in group 3 (p < 0.01). Median necrosis scores were 3.36 for rats receiving acetaminophen alone (p < 0.001, compared with groups 2-6), 1.45-1.81 for groups 2-5 (p > 0.05, compared with each other), and 0.18 for control rats (p < 0.001, compared with groups 1-5). In conclusion, the administration of 4-MP and/or NAC after 4 h of administering toxic dose of acetaminophen, inhibits hepatotoxicity in rats. There was no difference between the 4-MP and NAC-treated groups as reflected by comparable levels of serum transaminases and the degree of hepatic necrosis. Combining of 4-MP and NAC offers no benefit.

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“…66 DIC has been reported in pregnancy as the result of acetaminophen-induced hepatic necrosis associated with overdose-induced fetal death. 540 DIC has also been reported after hepatic necrosis from acetaminophen alone. 541 Cases of fulminant hyperpyrexia induced by the cytotoxic agents bleomycin and daunorubicin have been associated with shock, coma, and the development of DIC.…”

Section: Toxinsmentioning

confidence: 94%

Clinical Aspects of Disseminated Intravascular Coagulation: A Clinician's Point of View

Baker¹

1989

Semin Thromb Hemost

151

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DIC is a disorder of coagulation that is demonstrated to occur in many settings. In view of the fulminant nature of the disorder once it is fully activated, the potential for considerable morbidity and mortality, and the difficulty in treating this syndrome, the necessity for a thorough understanding of the disorder is clear. A high index of suspicion is absolutely essential; however, this requires a thorough knowledge of the medical and surgical disorders in which DIC is likely to occur. The presenting manifestations of DIC, the time course of development of the fulminant syndrome, and the specific complications of the disorder may be intrinsically related to the specific clinical characteristics of the underlying disease. Clinical evaluation of the patient must be comprehensive and consider not only the laboratory and clinical manifestations of DIC but the triggering illness. Without the ability to treat the underlying primary illness, controlling or abating the DIC may be difficult or impossible. This comprehensive review of the disease entities in which DIC is likely to occur and the associated clinical manifestations will, it is hoped, guide a more precise definition of the overall clinical picture that confronts the clinician when evaluating a patient with possible DIC.

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Acetaminophen Overdose with Fetal Demise

Cited by 39 publications

References 0 publications

Unintentional Chronic Acetaminophen Poisoning During Pregnancy Resulting in Liver Transplantation

Unintentional Chronic Acetaminophen Poisoning During Pregnancy Resulting in Liver Transplantation

Comparison of the Therapeutic Efficacy of 4-Methylpyrazole andN-Acetylcysteine on Acetaminophen (Paracetamol) Hepatotoxicity in Rats

Clinical Aspects of Disseminated Intravascular Coagulation: A Clinician's Point of View

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