Rhabdomyolysis and Necrotic Bowel After Acetaminophen and Ibuprofen Overdose

Nelson, H. L.; Katz, Daniel; Dunn, Ty B.; Singh, Gajendra; Voigt, Michael; Whitaker, Eric E.; Thomsen, David J.

doi:10.1592/phco.27.4.608

Cited by 12 publications

(5 citation statements)

References 17 publications

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“…There have been case reports of APAP-associated rhabdomyolysis, 25,26 with renal injury occurring when CK levels are greater than 5000 IU/L. 27 In our cohort, increased CK levels occurred quite frequently in shock as well as during APAP-related ALF, although very high levels were quite rare.…”

Section: Discussionmentioning

confidence: 53%

Risk Factors and Outcomes of Acute Kidney Injury in Patients With Acute Liver Failure

Tujios

Hynan

Vázquez

et al. 2015

Clinical Gastroenterology and Hepatology

123

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BACKGROUND & AIMS Patients with acute liver failure (ALF) frequently develop renal dysfunction, yet its overall incidence and outcomes have not been fully assessed. We investigated the incidence of acute kidney injury (AKI) among patients with ALF, using defined criteria to identify risk factors and to evaluate its effect on overall outcomes. METHODS We performed a retrospective review of data from 1604 patients enrolled in the Acute Liver Failure Study Group, from 1998 through 2010. Patients were classified by the Acute Kidney Injury Network criteria, as well as for etiology of liver failure (acetaminophen-based, ischemic, and all others). RESULTS Seventy percent of patients with ALF developed AKI, and 30% received renal replacement therapy (RRT). Patients with severe AKI had higher international normalized ratio values than those without renal dysfunction (P < .001), and a higher proportion had advanced-grade coma (coma grades 3 or 4; P < .001) or presented with hypotension requiring vasopressor therapy (P < .001). A greater proportion of patients with acetaminophen-induced ALF had severe kidney injury than of patients with other etiologies of ALF; 34% required RRT, compared with 25% of patients with ALF not associated with acetaminophen or ischemia (P < .002). Of the patients with ALF who were alive at 3 weeks after study entry, significantly fewer with AKI survived for 1 year. Although AKI reduced the overall survival time, more than 50% of patients with acetaminophen-associated or ischemic ALF survived without liver transplantation (even with RRT), compared with 19% of patients with ALF attribute to other causes (P < .001). Only 4% of patients requiring RRT became dependent on dialysis. CONCLUSIONS Based on a retrospective analysis of data from more than 1600 patients, AKI is common in patients with ALF and affects short- and long-term outcomes, but rarely results in chronic kidney disease. Acetaminophen-induced kidney injury is frequent, but patients have better outcomes than those with other forms of ALF.

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Section: Discussionmentioning

confidence: 53%

Risk Factors and Outcomes of Acute Kidney Injury in Patients With Acute Liver Failure

Tujios

Hynan

Vázquez

et al. 2015

Clinical Gastroenterology and Hepatology

123

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“…35 Some studies reported rhabdomyolysis following acetaminophen overdose. 36,37 Although rhabdomyolysis is also rarely seen after high doses of acetaminophen and might be attributed to non-declared co-intoxicants, our study demonstrated that patients who developed rhabdomyolysis have 10 times more serious consequences without this symptom. Similarly, high doses of acetaminophen and rhabdomyolysis might result in transaminase elevation but with different patterns in these two different clinical settings.…”

Section: Discussionmentioning

confidence: 53%

Prognostic factors of acetaminophen exposure in the United States: An analysis of 39,000 patients

et al. 2021

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Acetaminophen is a frequently used over-the-counter or prescribed medication in the United States. Exposure to acetaminophen can lead to acute liver cytolysis, acute liver failure, acute kidney injury, encephalopathy, and coagulopathy. This retrospective cohort study (1/1/2012 to 12/31/2017) investigated the clinical outcomes of intentional and unintentional acetaminophen exposure using the National Poison Data System data. The frequency of outcomes, chronicity, gender, route of exposure, the reasons for exposure, and treatments as described. Binary logistic regression was used to estimate the prognostic factors and odds ratios (OR) with 95% confidence intervals (CI) for outcomes. This study included 39,022 patients with acetaminophen exposure. Our study demonstrated that the likelihood of developing severe outcomes increased by aging (OR = 1.12, 95% CI: 1.08–1.015) and was lower in females (OR = 0.88, 95% CI: 0.78–0.99). Drowsiness/lethargy (OR = 1.48, 95% CI: 1.22–1.82), agitation (OR = 1.66, 95% CI: 1.11–2.50), coma (OR = 23.95, 95% CI: 17.05–33.64), bradycardia (OR = 2.29, 95% CI: 1.22–4.32), rhabdomyolysis (OR = 8.84, 95% CI: 3.71–21.03), hypothermia (OR = 4.1, 95% CI: 1.77–9.51), and hyperthermia 2.10 (OR = 2.10, 95% CI: 1.04–4.22) were likely associated with major outcomes or death. Treatments included intravenous N-acetylcysteine (61%), oral N-acetylcysteine (10%), vasopressor (1%), hemodialysis (0.7%), fomepizole (0.1%), hemoperfusion (0.03%), and liver transplant (0.1%). In conclusion, it is important to consider clinical presentations of patients with acetaminophen toxicity that result in major outcomes and mortality to treat them effectively.

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“…Myalgia following infusion is reported in 65-70% of postmenopausal women but is typically self-limiting [12,13]. While acetaminophen would most likely be associated with myopathy due to its use in treating pain, there are several reports of rhabdomyolysis as a symptom of acetaminophen overdose [19][20][21].…”

Section: Discussionmentioning

confidence: 99%

Mining and visualizing high-order directional drug interaction effects using the FAERS database

Yao

Tsang

Sun

et al. 2020

BMC Med Inform Decis Mak

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Background Adverse drug events (ADEs) often occur as a result of drug-drug interactions (DDIs). The use of data mining for detecting effects of drug combinations on ADE has attracted growing attention and interest, however, most studies focused on analyzing pairwise DDIs. Recent efforts have been made to explore the directional relationships among high-dimensional drug combinations and have shown effectiveness on prediction of ADE risk. However, the existing approaches become inefficient from both computational and illustrative perspectives when considering more than three drugs. Methods We proposed an efficient approach to estimate the directional effects of high-order DDIs through frequent itemset mining, and further developed a novel visualization method to organize and present the high-order directional DDI effects involving more than three drugs in an interactive, concise and comprehensive manner. We demonstrated its performance by mining the directional DDIs associated with myopathy using a publicly available FAERS dataset. Results Directional effects of DDIs involving up to seven drugs were reported. Our analysis confirmed previously reported myopathy associated DDIs including interactions between fusidic acid with simvastatin and atorvastatin. Furthermore, we uncovered a number of novel DDIs leading to increased risk for myopathy, such as the co-administration of zoledronate with different types of drugs including antibiotics (ciprofloxacin, levofloxacin) and analgesics (acetaminophen, fentanyl, gabapentin, oxycodone). Finally, we visualized directional DDI findings via the proposed tool, which allows one to interactively select any drug combination as the baseline and zoom in/out to obtain both detailed and overall picture of interested drugs. Conclusions We developed a more efficient data mining strategy to identify high-order directional DDIs, and designed a scalable tool to visualize high-order DDI findings. The proposed method and tool have the potential to contribute to the drug interaction research and ultimately impact patient health care. Availability and implementation http://lishenlab.com/d3i/explorer.html

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Rhabdomyolysis and Necrotic Bowel After Acetaminophen and Ibuprofen Overdose

Cited by 12 publications

References 17 publications

Risk Factors and Outcomes of Acute Kidney Injury in Patients With Acute Liver Failure

Risk Factors and Outcomes of Acute Kidney Injury in Patients With Acute Liver Failure

Prognostic factors of acetaminophen exposure in the United States: An analysis of 39,000 patients

Mining and visualizing high-order directional drug interaction effects using the FAERS database

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