1. Acetaminophen induced Acute Liver Failure
Hakeem

2. Transaminitis
Broad differential for mild (<5X normal) ALT/AST elevations
ALT predominant
Chronic viral hepatitis
Autoimmune
A-1 antitrypsin, hemochromatosis, Wilson’s
Medication/Toxin
Steatohepatitis
AST predominant
EtOH-related
Cirrhosis
Non-hepatic
Hemolysis
Myopathy
Thyroid
Limited etiology for severe (>15X normal) ALT/ASE elevations
Acute viral
Medication/toxin
Ischemia
Acute biliary obstruction
Acute Budd-Chiari

3. Causes of acute liver failure
Acetaminophen 39%
Other drugs 13%
Hep A 4%
Hep B 7%

4. Time course
Biochemical signs of liver failure appear within 24 to 48 hours after the time of overdose
Produce centrilobular necrosis in the liver

5. Intentional or nonintentional?
A recent study showed that acetaminophen overdose is on the rise
48% were nonintentional
Majority (81%) of nonintentional had either an acute or chronic painful medical condition
63% were taking a narcotic-ACM analgesic chronically

6. Patient profile
~75% are women
~90% are white
Median age years

7. Common metabolic disturbances
Hypophosphatemia
Hypoglycemia
Metabolic acidosis

8. Treatment Gastric lavage/charcoal/NAC
Liver transplant remains the gold standard treatment for patients who develop acute liver failure
Acetaminophen is the leading cause of drug- induced liver failure requiring transplantation
This accounts for 8-13% of all causes of acute liver failure that require transplantation