Acute versus chronic alcohol consumption in acetaminophen‐induced hepatotoxicity

  title={Acute versus chronic alcohol consumption in acetaminophen‐induced hepatotoxicity},
  author={Lars Ebbe Schmidt and Kim Peder Dalhoff and Henrik Enghusen Poulsen},
The aim of this study was to determine by multivariate analysis how alcohol and other factors affect the clinical course and outcome in patients with acetaminophen (paracetamol) poisoning. A total of 645 consecutive patients admitted from 1994 to 2000 with single‐dose acetaminophen poisoning were studied, giving special attention to alcohol history, time between overdose and intravenous N‐acetylcysteine (NAC) treatment (“time to NAC”), and other data available at the time of admittance. Up… 

Are recommended doses of acetaminophen hepatotoxic for recently abstinent alcoholics? A randomized trial

In conclusion, therapeutic doses of sustained-release acetaminophen cause a measurable decrease in serum α-GST during the first days of abstinence from chronic alcohol use, providing some reassurance that short courses ofacetaminophen are unlikely to cause subclinical hepatocellular injury in recently abstinent alcoholics.

Hepatitis C, alcohol abuse, and unintentional overdoses are risk factors for acetaminophen‐related hepatotoxicity

This commendable study adds to the literature supporting an association between liver disease and acetaminophen-related ALI, and reanalyzed the Nationwide Inpatient Sample database with adjustment for this factor using codes for external causes of injury that have been validated for defining suicidal intent due to poisoning.

N-Acetylcysteine for Preventing Acetaminophen-Induced Liver Injury: A Comprehensive Review

Timing of treatment, ranging from 8 to 24 h from APAP overdose, regardless of the regimen or route of administration, is important to prevent or minimize liver damage, particularly in children and in elderly and obese patients.

Acetaminophen‐induced acute liver failure: Results of a United States multicenter, prospective study

In conclusion, acetaminophen hepatotoxicity far exceeds other causes of acute liver failure in the United States, and education of patients, physicians, and pharmacies to limit high‐risk use settings is recommended.

Plasma procalcitonin may be an early predictor of liver injury in acetaminophen poisoning: A prospective cohort study

PCT on admission is associated with liver injury in acetaminophen poisoning and might be used as a predictive tool of liver injury to improve clinical decision‐making.

Acetaminophen Self-Poisoning: Suicidal and Accidental

Overdose with acetaminophen in adults was often indications of suicidal behavior, and in children was usually of accidental type, and the outcome was generally good in spite of commonacetaminophen poisoning.

ORIGINAL ARTICLE Influence of acetaminophen at therapeutic doses on surrogate markers of severity of acute viral hepatitis

The use of acetaminophen at therapeutic doses was associated with greater alterations of surrogate markers of theseverity of acute viral hepatitis especially hepatitis A, and this was related to cumulated dosages and correlated to the time relatedacetaminophen plasma concentrations.

Characteristics and Outcomes of Acetaminophen Overdose and Hepatotoxicity in Thailand

Most cases of APAP overdose in Thailand appear to be young women with intentional ingestion, and despite N-acetylcysteine therapy, hepatotoxicity including acute liver failure was observed in a small proportion of patients, particularly those with unintentional overdose and chronic alcohol drinking.

Impact of liver disease, alcohol abuse, and unintentional ingestions on the outcomes of acetaminophen overdose.




The Effect of Chronic Alcohol Intake on Prognosis and Outcome in Paracetamol Overdose

Chronic alcohol intake above suggested limits is an adverse prognostic feature in cases of severe paracetamol overdose and is partly related to increased nephrotoxicity.

Acetaminophen (paracetamol) hepatotoxicity with regular intake of alcohol: Analysis of instances of therapeutic misadventure

Evidence of hepatic injury in regular users of alcohol, especially chronic alcoholics, who take APAP with therapeutic intent is provided, and the syndrome of liver injury is distinctive, marked by uniquely elevated levels of AST, and poses a significant threat.

Association of acetaminophen hepatotoxicity with fasting and ethanol use.

Acetaminophen hepatotoxicity after an overdose appears to be enhanced by fasting in addition to alcohol ingestion, and was associated with fasting and less commonly with alcohol use.

Acetaminophen toxicity in an urban county hospital.

In an urban county hospital, patients hospitalized with acetaminophen toxicity related to accidental misuse had higher rates of morbidity and mortality than those who attempted suicide, even though the latter had taken more acetamine.

Risk factors in the development of adverse reactions to N-acetylcysteine in patients with paracetamol poisoning.

Asthma must be considered a risk factor in the development of side-effects to N-acetylcysteine and there is no reason to withhold NAC from any patient with paracetamol poisoning.

Acetaminophen overdose. 662 cases with evaluation of oral acetylcysteine treatment.

Acute alcohol use resulted in less severe toxic reactions than in those patients without acute alcohol use and those patients with no history of chronic alcohol use, and no consistent difference in hepatotoxicity could be demonstrated.

Glutathione deficiency in alcoholics: risk factor for paracetamol hepatotoxicity.

The data indicate that low GSH may be a risk factor for paracetamol hepatotoxicity in alcoholics because a lower dose of par acetamol will be necessary to deplete GSH below the critical threshold concentration where hepatocellular necrosis starts to occur.

Metabolic basis for high paracetamol dosage without hepatic injury: a case study

A combination of slow par acetamol absorption, enhanced detoxication of paracetamol (by sulphation) and reduced metabolism to potentially cytotoxic metabolites may have reduced the risk of liver damage in this patient.

Paracetamol medication and alcohol abuse: a dangerous combination for the liver and the kidney.

It seems reasonable to recommend that paracetamol should be prescribed with great caution to alcoholics, and absolutely not for continuous use.