Acute liver failure following paracetamol overdose

Abstract

Background Acute liver failure is a rare syndrome comprising a coagulopathy of liver origin, jaundice and encephalopathy in a patient with no prior history of liver disease. Paracetamol overdose is the leading cause of acute liver failure in the United Kingdom and often presents with extrahepatic organ dysfunction requiring critical care. Presentation: We present the case of a patient with hyper acute liver failure secondary to paracetamol overdose. Management and discussion: Management focused on ensuring the correct diagnosis had been made, administering N-acetyl cysteine, fluid resuscitation and broad spectrum antimicrobials. Early intubation and transfer to a transplant centre were undertaken following development of hepatic encephalopathy. Neuroprotective measures and hypertonic saline were instituted to reduce the risk of intracranial hypertension. High dose haemofiltration was also started to help reduce ammonia levels. Aggressive critical care therapies with specialised input results in good outcomes for patients admitted with paracetamol induced hyper acute liver failure. Liver transplant is reserved for those patients unlikely to survive with medical treatment alone.

Hepatic Sirt6 activation abrogates acute liver failure

“…Manifests with a variety of insults to liver cells, a consistent pattern of rapid-onset impaired coagulation, elevation of aminotransferases, and alteration of mental status, ALF is seen presents unique challenges in clinical management and carries a very high mortality. Causes of ALF include overdose of medicine, hepatic ischemia, herbal and dietary poisoning, and autoimmune hepatitis [ 3 – 5 ]. Among these, medicine overdose remains most frequent cause of ALF in United States of America and many other countries [ 6 ].…”