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Acetaminophen induced Acute Liver Failure

Acetaminophen induced Acute Liver Failure. Hakeem. Limited etiology for severe (>15X normal) ALT/ASE elevations Acute viral Medication/toxin Ischemia Acute biliary obstruction Acute Budd-Chiari. Transaminitis. Broad differential for mild (<5X normal) ALT/AST elevations ALT predominant

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Acetaminophen induced Acute Liver Failure

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  1. Acetaminophen induced Acute Liver Failure Hakeem

  2. Limited etiology for severe (>15X normal) ALT/ASE elevations • Acute viral • Medication/toxin • Ischemia • Acute biliary obstruction • Acute Budd-Chiari Transaminitis • Broad differential for mild (<5X normal) ALT/AST elevations • ALT predominant • Chronic viral hepatitis • Autoimmune • A-1 antitrypsin, hemochromatosis, Wilson’s • Medication/Toxin • Steatohepatitis • AST predominant • EtOH-related • Cirrhosis • Steatohepatitis • Non-hepatic • Hemolysis • Myopathy • Thyroid

  3. Causes of acute liver failure • Acetaminophen 39% • Other drugs 13% • Hep A 4% • Hep B 7%

  4. Time course • Biochemical signs of liver failure appear within 24 to 48 hours after the time of overdose • Produce centrilobular necrosis in the liver

  5. Intentional or nonintentional? • A recent study showed that acetaminophen overdose is on the rise • 48% were nonintentional • Majority (81%) of nonintentional had either an acute or chronic painful medical condition • 63% were taking a narcotic-ACM analgesic chronically

  6. Patient profile • ~75% are women • ~90% are white • Median age 36-37 years

  7. Common metabolic disturbances • Hypophosphatemia • Hypoglycemia • Metabolic acidosis

  8. Treatment • Gastric lavage/charcoal/NAC • Liver transplant remains the gold standard treatment for patients who develop acute liver failure • Acetaminophen is the leading cause of drug-induced liver failure requiring transplantation • This accounts for 8-13% of all causes of acute liver failure that require transplantation

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