Being overweight or obese as a risk factor for acute liver injury secondary to acute acetaminophen overdose

Su, Mark K.; Chomchai, Chulathida

doi:10.1002/pds.4339

Cited by 23 publications

(21 citation statements)

References 20 publications

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“…Furthermore, there are adverse effect concerns when increasing doses beyond those needed to reach the analgesic ceiling effect [27][28][29]. Some adverse effects (e.g., acetaminopheninduced liver injury) may be more frequent in patients with obesity [30,31]. Therefore, no size descriptor recommendation is needed for analgesic agents administered by non-weight-based dosing regimens.…”

Section: Non-opioid Analgesicsmentioning

confidence: 99%

Drug dosing in the critically ill obese patient—a focus on sedation, analgesia, and delirium

Erstad

Barletta

2020

Crit Care

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Practice guidelines provide clear evidence-based recommendations for the use of drug therapy to manage pain, agitation, and delirium associated with critical illness. Dosing recommendations however are often based on strategies used in patients with normal body habitus. Recommendations specific to critically ill patients with extreme obesity are lacking. Nonetheless, clinicians must craft dosing regimens for this population. This paper is intended to help clinicians design initial dosing regimens for medications commonly used in the management of pain, agitation, and delirium in critically ill patients with extreme obesity. A detailed literature search was conducted with an emphasis on obesity, pharmacokinetics, and dosing. Relevant manuscripts were reviewed and strategies for dosing are provided.

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Section: Non-opioid Analgesicsmentioning

confidence: 99%

Drug dosing in the critically ill obese patient—a focus on sedation, analgesia, and delirium

Erstad

Barletta

2020

Crit Care

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“…For a more detailed assessment of the risk factors for hepatotoxicity, and in view of the fact that a considerable proportion of patients presented with a moderate increase in plasma aminotransferase levels (over the normal range but below 1000 IU/L), we divided the study population into three groups, as described above. In the available literature, there are numerous studies that have discussed new risk factors for hepatotoxicity [ 9 , 10 , 11 , 15 , 16 , 19 , 20 , 21 , 22 , 23 , 24 ], including parameters related to the patient’s medical history, acetaminophen dose, biochemical findings, or a combination thereof. Quantitative and qualitative medical variables, which might serve as such risk factors in the studied population, are presented in Table 1 and Table 2 .…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Hepatotoxicity Due to Paracetamol Overdose in Adults

et al. 2021

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Background and Objectives: Over-the-counter availability and a good safety profile make paracetamol one of the most common analgesics in developed countries but also the leading cause of liver failure due to overdose. The objectives of the study were to identify modifiable risk factors for severe hepatotoxicity following paracetamol overdose in adults. Materials and Methods: A retrospective cohort study involved the consecutive adult patients hospitalized in a toxicological center over a period of seven years due to paracetamol overdose. Complete medical datasets of laboratory and anamnestic variables were analyzed and validated by means of logistic regression model. Results: A total of 185 patients entered the study, including 25 individuals who developed severe hepatotoxicity (plasma aminotransferases levels above 1000 UI/L) and 31 individuals with mild to moderate liver injury (plasma aminotransferases levels above upper normal range, but below 1000 UI/L). In the univariable analysis, significant hepatotoxicity risk factors were male gender, alcohol abuse, an ingested paracetamol dose, and a timespan from ingestion to hospital admission. The later one was the only significant risk factor in the multivariable model (adjusted odds ratio 1.08; 95% CI: 1.03–1.12). Conclusions: A delay in hospital admission, resulting in a delayed administration of disease-specific treatment outweighs any other known risk factors of paracetamol-induced hepatotoxicity.

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“…In both animal and human studies, diabetes mellitus is an independent risk factor for severe DILI outcomes . For example, one recent study demonstrated that overweight or obese patients were more likely to develop acetaminophen hepatotoxicity .…”

Section: Demographics Of Patients With Severe Dilimentioning

confidence: 99%

“…22 In both animal and human studies, diabetes mellitus is an independent risk factor for severe DILI outcomes. 19,[23][24][25] For example, one recent study demonstrated that overweight or obese patients were more likely to develop acetaminophen hepatotoxicity. 23 In addition, a recent study of 259 patients with inflammatory bowel disease receiving immunosuppressants demonstrated that those with baseline steatosis were more likely to develop liver injury.…”

Section: Demog R Aphi C S Of Patients With S E Vere D Ilimentioning

confidence: 99%

“…19,[23][24][25] For example, one recent study demonstrated that overweight or obese patients were more likely to develop acetaminophen hepatotoxicity. 23 In addition, a recent study of 259 patients with inflammatory bowel disease receiving immunosuppressants demonstrated that those with baseline steatosis were more likely to develop liver injury. 24 The mechanism by which diabetic patients and those with underlying hepatic steatosis may be more susceptible to DILI remains unclear but possibly related to altered cytochrome-P450 or transporter expression resulting in aberrant drug pharmacokinetics or disposition.…”

Section: Demog R Aphi C S Of Patients With S E Vere D Ilimentioning

confidence: 99%

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The diagnosis and management of idiosyncratic drug‐induced liver injury

Hassan

Fontana

2018

Liver International

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Drug-induced liver injury (DILI) is an uncommon but important cause of liver disease that can arise after exposure to a multitude of drugs and herbal and dietary supplements. The severity of idiosyncratic DILI varies from mild serum aminotransferase elevations to the development of severe liver injury that can progress to acute liver failure resulting in death or liver transplantation within days of DILI onset. Chronic liver injury that persists for more than 6 months after DILI onset is also becoming increasingly recognized in up to 20% of DILI patients. Host demographic (age, gender, race), clinical and laboratory features at DILI onset have been associated with the severity and outcome of liver injury in DILI patients. In addition to cessation of the suspect drug, other medical interventions including the use of N-acetylcysteine and corticosteroids in selected patients have shown some clinical benefit, but additional prospective studies are needed. A number of promising diagnostic, prognostic and mechanistic serum and genetic biomarkers may help improve our understanding of the pathogenesis and treatment of idiosyncratic DILI.

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Being overweight or obese as a risk factor for acute liver injury secondary to acute acetaminophen overdose

Cited by 23 publications

References 20 publications

Drug dosing in the critically ill obese patient—a focus on sedation, analgesia, and delirium

Drug dosing in the critically ill obese patient—a focus on sedation, analgesia, and delirium

Risk Factors for Hepatotoxicity Due to Paracetamol Overdose in Adults

The diagnosis and management of idiosyncratic drug‐induced liver injury

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