Paracetamol acute liver failure patients

Patient 5 Paracetamol overdose Acute liver failure... 

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. 

At present, there is no specific laboratory investigation which facilitates the diagnosis of acute liver failure. In view of the severity of this clinical picture, there are, however, a number of laboratory parameters which show marked pathological changes and thus require full diagnostic clarification. Activin A serum levels were elevated, especially in patients with acute liver failure, due to a paracetamol overdose. This did not affect the final outcome, but was possibly a factor in the inhibition of... 

Dahlin DC, Miwa GT, Lu AY, Nelson SD (1984) N-acetyl-p-benzoquinone imine a cytochrome P-450-mediated oxidation product of acetaminophen. Proc Natl Acad Sci USA 81 1327-1331 Davem TJ 2nd, James LP, Hinson JA, Poison J, Larson AM, Fontana RJ, Lalani E, Munoz S, Shakil AO, Lee WM (2006) Measurement of serum acetaminophen-protein adducts in patients with acute liver failure. Gastroenterology 130 687-694 Davidson DG, Eastham WN (1966) Acute liver necrosis following overdose of paracetamol. Br Med J 5512 497 99... 

DILI is divided by type of occurrence into predictable and idiosyncratic. Predictable DILI is the most common form and follows dose-response curves and is typically present in all patients during overdose. The archetypical example of predictable DILI is that of paracetamol hepato-toxicity and is the leading cause of acute liver failure in... 

Liver It is important to consider paracetamol dosage reduction in patients with low body weights or with other susceptibility factors for hepatotoxicity. In two adults weighing 30 and 44 kg (body mass indices 12 and 17 kg/m ) acute liver failure (in one case with a fatal outcome) occurred after administration of paracetamol 4 g/day [IS ]. 

The difference in overall survival between paracetamol-related and non-paracetamol-related acute liver failure was not statistically significant Patients with paracetamol-related acute liver failure required dialysis before transplantation more often than all the other groups (27% versus 3-10%). Cox proportional hazards regression analysis showed that the independent pre-transplantation predictors of death after transplantation were being on life support, liver failure due to antiepileptic drugs at age under 18 years, and a raised serum creatinine concentration. 

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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