Gastroenterology

Gastroenterology

Volume 109, Issue 6, December 1995, Pages 1907-1916
Gastroenterology

A 7-year experience of severe acetaminophen-induced hepatotoxicity (1987–1993)

https://doi.org/10.1016/0016-5085(95)90758-0Get rights and content

Abstract

Background & Aims: Five hundred sixty patients admitted between January 1, 1987, and December 31, 1993, with severe acetaminophen-induced hepatotoxicity were studied. The aim of this study was to identify why severe acetaminophen-induced hepatotoxicity still occurs and to determine how known risk factors and advances in management have affected the pattern of illness and outcome. Methods: This was a retrospective study of the etiologic factors and the clinical course of all acetaminophen-related admissions. Results: The number of admissions increased from 58 in 1987 to 123 in 1993. During the corresponding period, overall survival improved from just <50% to 78%. The percentage of admissions treated with N-acetylcysteine increased from 40% in 1987 to 83% in 1993. The frequency with which grade III or IV encephalopathy developed decreased from 62% in 1987 to 40% in 1993, and the percentage of these patients who developed cerebral edema decreased from 61% to 45% during the same period. There was an increase in both the number of patients transplanted and the survival of those managed medically. Conclusions: Severe acetaminophen-induced hepatotoxicity remains a serious condition, but the increasing use of N-acetylcysteine, advances in medical management, and the increasing availability of transplantation have resulted in a significant improvement in survival rates.

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    Dr. Makin is the recipient of a British Digestive Foundation Training Fellowship.

    The authors thank Dr. John Spooner for his continuing input into this work and his helpful comments.

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