Reversible Fulminant Hepatitis Secondary to Cocaine in the Setting of β-Blocker Use

Sharma, Rohan; Kapoor, Nidhi; Chaudhari, Kaustubh S; Scofield, R. Hal

doi:10.1177/2324709620924203

Cited by 3 publications

(2 citation statements)

References 21 publications

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“…It has been suggested that cocaine reduces hepatic blood flow, causing shock liver, or ischemic hepatitis [ 10 , 11 ]. The findings of shock liver have been associated with cocaine-induced hepatitis in several case reports [ 9 , 11 - 13 ]. Cocaine-induced ischemic hepatitis is consistent with the features in our case, as the patient’s condition progressed to hypotension and tachycardia, requiring vasopressors.…”

Section: Discussionmentioning

confidence: 99%

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

Mitchell¹,

Rogers²

2023

Cureus

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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.

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Section: Discussionmentioning

confidence: 99%

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

Mitchell¹,

Rogers²

2023

Cureus

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“…Furthermore, despite the global COVID-19 pandemic, European authorities have intercepted at seaports growing amounts of cocaine in 2020 [5]. All the while, case reports detailing the harmful consequences of cocaine use abound [7][8][9][10][11][12][13][14][15][16][17][18][19][20].…”

Section: Introductionmentioning

confidence: 99%

Cocaine: An Updated Overview on Chemistry, Detection, Biokinetics, and Pharmacotoxicological Aspects including Abuse Pattern

Bravo

Faria

Brito-da-Costa

et al. 2022

Toxins

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Cocaine is one of the most consumed stimulants throughout the world, as official sources report. It is a naturally occurring sympathomimetic tropane alkaloid derived from the leaves of Erythroxylon coca, which has been used by South American locals for millennia. Cocaine can usually be found in two forms, cocaine hydrochloride, a white powder, or ‘crack’ cocaine, the free base. While the first is commonly administered by insufflation (‘snorting’) or intravenously, the second is adapted for inhalation (smoking). Cocaine can exert local anaesthetic action by inhibiting voltage-gated sodium channels, thus halting electrical impulse propagation; cocaine also impacts neurotransmission by hindering monoamine reuptake, particularly dopamine, from the synaptic cleft. The excess of available dopamine for postsynaptic activation mediates the pleasurable effects reported by users and contributes to the addictive potential and toxic effects of the drug. Cocaine is metabolised (mostly hepatically) into two main metabolites, ecgonine methyl ester and benzoylecgonine. Other metabolites include, for example, norcocaine and cocaethylene, both displaying pharmacological action, and the last one constituting a biomarker for co-consumption of cocaine with alcohol. This review provides a brief overview of cocaine’s prevalence and patterns of use, its physical-chemical properties and methods for analysis, pharmacokinetics, pharmacodynamics, and multi-level toxicity.

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Metoprolol succinate

2020

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Reversible Fulminant Hepatitis Secondary to Cocaine in the Setting of β-Blocker Use

Cited by 3 publications

References 21 publications

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

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

Cocaine: An Updated Overview on Chemistry, Detection, Biokinetics, and Pharmacotoxicological Aspects including Abuse Pattern

Metoprolol succinate

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