- Page navigation anchor for Acetaminophen as a cause of ‘non-acetaminophen-related acute liver failure’Acetaminophen as a cause of ‘non-acetaminophen-related acute liver failure’
Jawad et al.[1] report on an 18 year old patient who developed acute liver failure following infection with hepatitis A virus (HAV) and norovirus. Presenting symptoms included “4-day history fever (self-reported 38.5°C), chills, abdominal pain, anorexia, and 2 days of emesis.” The authors stated that the patient had taken 4 g acetaminophen each day over the previous 4 days. Subsequent tests showed an elevated ALT (>7000 U/L) and an INR that increased up to 2.1 within the first 24 hours of presentation. He was categorized as having grade II hepatic encephalopathy.
In their discussion of this case, one aspect that was not addressed was whether the multiple doses of acetaminophen could have acted synergistically with the viral infection to induce liver failure. Although this patient did not exceed the recommend dose for this drug, one might question how often a therapeutic dose can induce liver failure. Animal and human studies have suggested that acute viral infections can enhance the hepatotoxicity of acetaminophen,[2] including patients with acute HAV infection. Rezende et al.[3] examined 40 patients with acute HAV who had acetaminophen intake quantified. In comparison to no use, those who used acetaminophen had significantly higher ALT, bilirubin, and a higher risk of encephalopathy – even though acetaminophen intake was low and within recommended doses. Yaghi et al.[4] conducted a prospective study of 37 consecutive patients hospitalized for acute viral hepati...
Show MoreCompeting Interests: None declared.References
- 1. Jawad S, Coffin CS, Vaughan SD, et al. Acute hepatitis in an 18-year-old returning traveller. CMAJ 2024;196:E410-E414.
- 2. Levy M. Role of viral infections in the induction of adverse drug reactions. Drug Saf 1997;16:1-8.
- 3. Rezende G, Roque-Alfonso AM, Samuel D, et al. Viral and clinical factors associated with the fulminant course of hepatitis A infection. Hepatology 2004;38:613-8.
- 4. Yaghi C, Honein K, Boujaoude J, et al. Influence of acetaminophen at therapeutic doses on surrogate markers of severity of acute viral hepatitis. Gastroenterol Clin Biol 2006;30:763-8.
- 5. Hoption Cann SA. COVID-19 vaccine-related myocarditis: Could antipyretic drugs be a trigger? Infect Med (Beijing) 2023;2:49-50.
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