Acute hepatic failure paracetamol

Fulminant hepatic failure occurs in 1-5% of cases of paracetamol overdosage 3-6 days after ingestion (71), with frequent deaths in people who take 20-25 g. There is only a narrow margin between the normal maximum 24-hour dosage and that which can cause liver damage and acute hepatic failure. Undoubtedly, some people are more susceptible than most to paracetamol toxicity, since although 6 g has been reported as toxic in some cases, most toxicity is seen with 12 g upwards (72,73). Nomograms have been developed to show the relation between plasma paracetamol concentrations over time and the risk of a serious outcome (SEDA-18, 94). 

Paracetamol could be considered in a patient with acute liver failure caused by something other than a paracetamol overdose. Normal therapeutic doses of paracetamol can be used, but it may be prudent to extend the dosing interval in all patients with acute liver failure because a reduced clearance has been demonstrated in patients with acute viral hepatitis and a prolonged PT. 

Drug-drug iuteractious Sunitinib and paracetamol Acute fatal liver failure following the addition of levothyroxine in a patient taking sunitinib and paracetamol for a metastatic gastric stromal tumor has been reported. Sunitinib can cause hypothyroidism, and it is plausible that correction of the hepatic hypothyroidism with levothyroxine resulted in potentiation of... 

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