Authors: J. Kurtovic; S. M. Riordan

Source: Journal of Internal Medicine, Volume 253, Number 2, February 2003 , pp. 240-243(4)

Publisher: Wiley-Blackwell

Abstract:

Abstract. Kurtovic J, Riordan SM (The Prince of Wales Hospital and University of New South Wales, Sydney, Australia). Paracetamol-induced hepatotoxicity at recommended dosage (Case report). J Intern Med 2003; 253: 240–243.

In patients who develop liver damage following moderate paracetamol overdose in the order of 5–10 g daily, recent fasting and nutritional impairment have been identified as key precipitants. Hepatotoxicity caused by paracetamol at recommended dosage, in the absence of exposure to enzyme-inducing drugs, has recently been described as an idiosyncratic phenomenon. The possible importance of fasting and malnutrition in this setting is uncertain. We report a severely malnourished 53-year-old woman who developed severe hepatotoxicity whilst receiving paracetamol at recommended dosage (4 g daily) following a period of fasting, in the absence of enzyme-inducing agents. Subsequent paracetamol exposure up to 2.6 g daily thrice weekly, in the setting of ongoing malnutrition and fasting as before, did not lead to recurrent liver damage. These findings indicate that paracetamol-related liver damage occurring within recommended dosage guidelines can be a dose-dependent rather than necessarily idiosyncratic phenomenon, at least in the setting of recent fasting and severe malnutrition.

Keywords: hepatotoxicity; malnutrition; paracetamol

Document Type: Case report

DOI: http://dx.doi.org/10.1046/j.1365-2796.2003.01097.x

Affiliations: 1: Gastrointestinal and Liver Unit, The Prince of Wales Hospital and University of New South Wales, Sydney, Australia

Publication date: 2003-02-01

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