Reversible peripartum liver failure: A new perspective on the diagnosis, treatment, and cause of acute fatty liver of pregnancy, based on 28 consecutive cases

Castro, Mary Ames; Fassett, Michael J.; Reynolds, Telfer B.; Shaw, Kenneth N.F.; Goodwin, T. Murphy

doi:10.1016/s0002-9378(99)70567-3

Cited by 232 publications

(143 citation statements)

References 16 publications

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“…They were ruled out by history, exam and imaging studies. Concern was highest for AFLP which is a microvesicular steatotosis caused by a defect in mitochondrial β-oxidation leading to hepatotoxicity and liver failure usually in the third trimester [10]. The final pathology report proved to be inconsistent with AFLP.…”

Section: Discussionmentioning

confidence: 99%

Unintentional Chronic Acetaminophen Poisoning During Pregnancy Resulting in Liver Transplantation

Thornton

Minns

2012

J. Med. Toxicol.

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Introduction Acetaminophen (APAP) is a widely used medication in pregnancy and is considered safe. Unfortunately, APAP is also among the most commonly reported agents implicated in overdoses during pregnancy. We present a unique case of a pregnant patient with fulminant hepatic failure resulting in a liver transplant from repeated supratherapeutic ingestions of APAP. Case Report A 22 year pregnant female presented with abdominal pain and hepatotoxicity after taking supratherapeutic amounts of APAP to treat dental pain. The patient denied intentional or acute ingestion of APAP but did admit to taking approximately 8-9 grams of APAP per day for 10-14 days for dental pain. Other cause of hepatotoxicity, including acute fatty liver of pregnancy, were evaluated for and ruled out. She developed fulminant hepatic failure and required liver transplantation which was successful. The pregnancy remained viable through the operation but intrauterine fetal demise occurred 2 weeks later. An MRI of the fetus showed extensive peri-cerebral and intraventricular hemorrhage with extensive periventricular leukomalacia. Discussion The degree of morbidity from repeated supratherapeutic ingestions of APAP seen in this case is rare and poorly described in a pregnant patient. There are no prior reports describing the need for liver transplant after repeated supratherapeutic ingestions of APAP during pregnancy. Along with the typical cause of hepatotoxicy several unique pregnancy-related causes also had to be evaluated for. This case highlights the significant morbidity that can occur with even unintentional APAP toxicity and the need to educate patients, especially pregnant patients, of the risk of excessive APAP use.

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Section: Discussionmentioning

confidence: 99%

Unintentional Chronic Acetaminophen Poisoning During Pregnancy Resulting in Liver Transplantation

Thornton

Minns

2012

J. Med. Toxicol.

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“…Usually such patients will present with nausea, vomiting, and abdominal cramps. First appear an impaired renal function and reduced plasma antithrombin levels, liver dysfunction following this [Castro, 1999]. Maternal renal impairment is aggravated by hypotension secondary to hemorrhage, which it is most likely to follow an emergency cesarean section.…”

Section: Acute Fatty Liver Of Pregnancymentioning

confidence: 99%

Renal Disease and Pregnancy

Hnat¹,

Sibai²

2009

GLOWM

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“…AFLP occurs in the second half of pregnancy, usually close to term. However, some patients may present and be diagnosed after delivery (45).…”

Section: Prognosismentioning

confidence: 99%

“…Most severely ill patients recover and have no sequelae of the liver disease itself (45). The maternal mortality rate was very high until 1970 (92%).…”

Section: Prognosismentioning

confidence: 99%