Clinical Features of Acetaminophen Toxicity

Acetaminophen hepatotoxicity: An update

“…When a patient presents with AST or ALT levels of greater than 1000, the major differential diagnosis includes drug-induced hepatotoxicity (eg, acetaminophen or carbon tetrachloride), "shock liver," fulminant viral-induced liver injury, and, in unusual circumstances, the passing of a gallstone [1,40]. These liver enzyme levels tend to be much higher in acetaminophen hepatotoxicity than in viral liver disease, and as the patient improves, levels drop more rapidly [1,40] (Fig.…”

“…However, in overdose situations, it is known to cause dose-dependent hepatotoxicity [1] Two major clinical patterns of acetaminophen hepatotoxicity have been characterized. The first is an overdose situation in which the patient attempts suicide [1,2••,3].…”

“…These patients often ar regular alcohol users or have been fasting, and they are taking acetaminophen to relieve pain. They typically present to the hospital with severe liver failure 3 to 4 days after consumption of the acetaminophen [1]. Recent studies by Schiodt et al [2••] showed that acetaminophen hepatotoxicity accounted for 40% of patients with acute liver failure in an urban county hospital setting in the United States.…”

Acute Renal Failure in an Alcoholic Patient Taking Therapeutic Doses of Acetaminophen

“…22 Other causes of the renal failure, including hypotension, hypovolemia, infectious agents, nephrotoxic agents, heavy metals, rhabdomyolysis, and snake or spider bites, should be sought and treated. 23 In this case, our patient did not experience hypotension or hypovolemia, as there was no evidence of orthostasis or shock.…”

“…In this process, however, toxic metabolites are formed that are detoxified by glutathione, which can be decreased in the malnourished person. 22 Adapted with modifications from Insepo stimulate cytochrome P-450, the enzymes are elevated, which leads to an increase in the amount of toxic metabolite formed. The glutathione stores are quickly depleted, and the toxic metabolites attach to macromolecules on the cell membranes, causing the cell to die.…”