Onset and recovery of hepatic and renal injury after deliberate acute paracetamol overdose

Abstract

A 54-year-old woman presented to hospital after deliberate acute ingestion of paracetamol 20 g. Despite early administration of a standardised acetylcysteine regimen, the patient developed acute liver impairment and acute renal impairment. Prolonged acetylcysteine administration and supportive measures allowed restoration of normal liver and renal function. Early presentation to hospital and prolonged duration of follow-up gave an unusual opportunity to examine the onset and duration of paracetamol-induced hepatic and renal impairment.

A Rare Case of Acetaminophen Toxicity Leading to Severe Kidney Injury

“…APAP overdose can cause significant hepatic and renal toxicity. However, there have been a few case reports of AKI secondary to APAP overdose requiring hemodialysis [1-5]. Ninety percent of ingested APAP is metabolized to nontoxic compounds that are excreted unchanged in the urine.…”

“…AKI occurs in about 2% - 10% of patients with APAP overdose and the rise in serum creatinine is usually seen two to five days after ingestion [1]. Despite this, APAP overdose requiring hemodialysis is relatively rare with documented examples described in a few case reports [2-5]. It is important to distinguish APAP-induced renal failure from other causes of kidney damage, including acute tubular necrosis from hypovolemia, along with hepatorenal syndrome, which can also happen in APAP overdose.…”

Evaluation of Physical Examination Findings in Acute Abdominal Patients Who Apply to Emergency Service

“…The increase in ALP activity that remained insignificant (P<0.16) between the PSO and PCT group means that restoration of normal liver function was not complete and the process of hepatic cellular repair related to the activity of this enzyme is slow or may require longer duration or greater concentration of PSO to return it toward control levels (25,26).…”

Life threatening pembrolizumabinduced myositis in a patient treated for advanced adenocarcinoma of the lung

“…Similar delays are observed for other drugs that cause liver toxicity Delayed onset of liver injury after intentional chloroform overdose: a case report and literature review via a toxic metabolite, for example paracetamol or isoniazid. 20,21 Administration of acetylcysteine has been described in several previous reports of chloroforminduced liver injury, although evidence of improved outcome are lacking. We administered intravenous acetylcysteine to our patient because we postulated that it might serve as an effective antidote against liver toxicity by allowing restoration of hepatic glutathione stores.…”