Acetaminophen induced Acute Liver Failure Hakeem Transaminitis Broad

Acetaminophen induced Acute Liver Failure Hakeem

Transaminitis • Broad differential for mild (<5 X normal) ALT/AST elevations ▫ ALT predominant Chronic viral hepatitis Autoimmune A-1 antitrypsin, hemochromatosis, Wilson’s Medication/Toxin Steatohepatitis ▫ AST predominant Et. OH-related Cirrhosis Steatohepatitis ▫ Non-hepatic Hemolysis Myopathy Thyroid • Limited etiology for severe (>15 X normal) ALT/ASE elevations – – – Acute viral Medication/toxin Ischemia Acute biliary obstruction Acute Budd-Chiari

Causes of acute liver failure • • Acetaminophen 39% Other drugs 13% Hep A 4% Hep B 7%

Time course • Biochemical signs of liver failure appear within 24 to 48 hours after the time of overdose • Produce centrilobular necrosis in the liver

Intentional or nonintentional? • A recent study showed that acetaminophen overdose is on the rise • 48% were nonintentional • Majority (81%) of nonintentional had either an acute or chronic painful medical condition • 63% were taking a narcotic-ACM analgesic chronically

Patient profile • ~75% are women • ~90% are white • Median age 36 -37 years

Common metabolic disturbances • Hypophosphatemia • Hypoglycemia • Metabolic acidosis

Treatment • Gastric lavage/charcoal/NAC • Liver transplant remains the gold standard treatment for patients who develop acute liver failure • Acetaminophen is the leading cause of druginduced liver failure requiring transplantation • This accounts for 8 -13% of all causes of acute liver failure that require transplantation