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Case Reports: Adverse drug reactions and complications
Intravenous acetaminophen associated with acute liver failure
  1. Maunoo Lee1,
  2. Joshua McCarron2,
  3. Aaron Balinski3 and
  4. Richard Bower1
  1. 1Department of Gastroenterology, Naval Medical Center San Diego, San Diego, California, USA
  2. 2Department of Gastroenterology, 99th Medical Group Mike O'Callaghan Military Medical Center, Nellis AFB, Nevada, USA
  3. 3Department of Internal Medicine, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
  1. Correspondence to Dr Maunoo Lee; maunoolee{at}gmail.com

Abstract

A woman in her mid-60s, without known liver disease, was admitted to the hospital with a partial malignant colonic obstruction. Over a 6-day course, she received a total of 13 g of intravenous acetaminophen not exceeding 4 g over a 24-hour period. She developed encephalopathy and an international normalised ratio of 6.1 meeting criteria for acute liver failure (ALF). She was treated with intravenous N-acetyl cysteine and other causes of liver failure were excluded. The patient was discharged with subsequent resolution of encephalopathy and improvement of her liver chemistries. Though ALF is rare, in countries where acetaminophen is readily available, almost 50% of ALF cases are acetaminophen-induced hepatotoxicity and most have been documented as oral ingestion of acetaminophen. We present a rare case of intravenous acetaminophen-induced ALF.

  • Liver disease
  • Unwanted effects / adverse reactions
  • Pharmacodynamics
  • Gastroenterology

https://doi.org/10.1136/bcr-2022-251305

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    Footnotes

    • Contributors ML wrote the manuscript and reviewed the literature. AB reviewed the literature and edited the figures. JM edited the manuscript and reviewed the literature. RB edited the manuscript and is the author guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.