PMID- 1455612
OWN - NLM
STAT- MEDLINE
DCOM- 19930107
LR  - 20131121
IS  - 0145-6296 (Print)
IS  - 0145-6296 (Linking)
VI  - 34
IP  - 5
DP  - 1992 Oct
TI  - Orthotopic liver transplants necessitated by acetaminophen-induced 
      hepatotoxicity.
PG  - 425-7
AB  - BACKGROUND: Acetaminophen-induced hepatotoxicity has been recognized since 1966. 
      Patients experiencing a massive hepatic insult due to acetaminophen (APAP) may 
      recover with minimal residual complications or develop fulminant hepatic 
      necrosis. We report 3 patients with hepatic failure due to an APAP overdose who 
      received orthotopic liver transplants and survived. CASE REPORTS: An 18-y-o 
      female ingested 60 500 mg APAP tablets (30 g). She presented with tachycardia and 
      lethargy stating that she had taken amoxipine, carbamazepine, and lorazepam. She 
      began to recover but on day 2 experienced an upper gastrointestinal bleed and 
      became hypotensive and hyperpyrexic. She developed hepatic encephalopathy and it 
      was then determined she had ingested APAP. Her APAP level was 13 micrograms/ml 96 
      h post-ingestion. She was successfully transplanted 19 d post-ingestion with 
      recovery. A 40-y-o female was admitted for flu-like symptoms persisting for 7 d. 
      She was jaundiced, hyperventilating and hypotensive. She admitted ingesting 
      approximately 17 g APAP over 36 h. Her APAP level was 12.2 micrograms/ml. Her 
      condition worsened and on day 3 she was in grade IV coma. She was successfully 
      transplanted 4 d post-arrival with recovery. A 16-y-o female ingested an unknown 
      amount of APAP. She presented approximately 24 h post-ingestion with a serum APAP 
      level of 130 micrograms/ml. Her condition deteriorated and she became 
      encephalopathic with grade IV coma. She was successfully transplanted on day 7 
      post-arrival. DISCUSSION: Hepatotoxicity can occur as a result of either acute or 
      chronic APAP overdose. Although n-acetylcysteine (NAC) is effective antidotal 
      therapy, it must be used within 8-12 h post-ingestion to be optimally effective. 
      Inaccurate patient histories may prevent NAC administration resulting in 
      hepatotoxicity. CONCLUSION: Liver transplantation is a viable option to be 
      considered in those APAP overdose patients who experience rapidly progressing 
      encephalopathy, hemolysis, and hepato-renal failure.
FAU - Mrvos, R
AU  - Mrvos R
AD  - Pittsburgh Poison Center, Children's Hospital of Pittsburgh, PA 15213.
FAU - Schneider, S M
AU  - Schneider SM
FAU - Dean, B S
AU  - Dean BS
FAU - Krenzelok, E P
AU  - Krenzelok EP
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - United States
TA  - Vet Hum Toxicol
JT  - Veterinary and human toxicology
JID - 7704194
RN  - 362O9ITL9D (Acetaminophen)
SB  - IM
MH  - Acetaminophen/*adverse effects
MH  - Adolescent
MH  - Adult
MH  - Drug Overdose
MH  - Female
MH  - Hepatic Encephalopathy/*chemically induced/*surgery
MH  - Humans
MH  - *Liver Transplantation
EDAT- 1992/10/01 00:00
MHDA- 1992/10/01 00:01
CRDT- 1992/10/01 00:00
PHST- 1992/10/01 00:00 [pubmed]
PHST- 1992/10/01 00:01 [medline]
PHST- 1992/10/01 00:00 [entrez]
PST - ppublish
SO  - Vet Hum Toxicol. 1992 Oct;34(5):425-7.