Guilt by association ▸

Increased risk of paracetamol induced liver injury in those with chronic alcohol abuse has been well recognised. But the concept of “therapeutic misadventure” with paracetamol has remained controversial. In a study involving 50 patients with acute hepatitis A infection, Rezende et al found female gender, low hepatitis A viral load, genotype other than 1A, and paracetamol intake to be associated with a fulminant course. Only subjects in whom accurate drug history was available were included in the analysis and daily paracetamol intake was well within the recommended dose (1–3 g) in all subjects. On univariate analysis, paracetamol intake was significantly associated with the risk of encephalopathy as well as high bilirubin levels, and the latter in turn independently predicted death or transplantation. These findings rekindle the debate as to whether paracetamol in therapeutic doses could contribute to the development of hepatic failure. Recent reports of the detection of paracetamol adducts in the sera of a significant proportion of patients with seronegative acute hepatic failure …