Acetaminophen poisoning now most common cause of acute liver failure in the USA

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Acetaminophen

poisoning now most common cause of acute liver failure in the USA

Article

Date: 30 Nov 2005

" Acetaminophen poisoning has become the most common cause of

acute liver failure in the United States, " report the

authors of a new study in the December

2005 issue of Hepatology, the official journal of the

American Association for the Study of Liver Diseases (AASLD). While attempted suicides

still account for many cases, almost half are the result of unintentional

overdose.

Acetaminophen is the most widely used pain reliever in the United

States--36 percent of Americans ingest it at

least once a month--but taking more than the recommended dose can lead to fatal

liver injury. While intentional overdoses generally present early after ingestion

and can be treated with N-acetylcysteine,

unintentional overdoses are usually not recognized until later. As a result,

lead author Anne M. Larson, M.D. of the University

of Washington and her colleagues

suspected that patients with acute liver failure from unintentional

acetaminophen overdoses would have more severe disease and worse outcomes than

patients with intentional overdoses.

To examine this hypothesis the researchers conducted a prospective study of

patients presenting with acute liver disease to any of 22 academic centers

participating in the Acute Liver Failure Study Group. Of 662 consecutive

patients over a six-year period between 1998 and 2003, 275 had

acetaminophen-related acute liver failure. For each of these patients, the

researchers gathered demographic and clinical information, including illness

severity, history of acetaminophen ingestion, and outcome.

Acute liver failure cases attributed to acetaminophen increased from 28 percent

in 1998 to 51 percent in 2003. These patients were predominantly female (74

percent) and Caucasian (88 percent.) While 44 percent had intentionally

overdosed on the drug in suicide attempts, 48 percent had overdosed

unintentionally, either by taking combinations of products containing

acetaminophen, or taking more than the recommended dosage of a single product

over time. Of all patients with

acetaminophen-related acute liver failure, 74 died, 23 received liver

transplants, and 178 survived without transplantation.

Those who had unintentionally overdosed were older, used multiple

acetaminophen-containing medications more frequently and waited longer to seek

care after their symptoms began. Most reported that they had been taking the

medications specifically for pain. They were more likely to have severe hepatic

encephalopathy than patients who had overdosed intentionally.

Sixty-three percent of patients who overdosed accidentally had been using

prescription narcotic/acetaminophen compounds. Thirty-eight percent had been

using two acetaminophen medications simultaneously. " This suggests

patients lack awareness of the hazards of over-the-counter acetaminophen use in

combination with prescribed agents, " the researchers say.

Some patients reported taking less than 4 grams of acetaminophen per day before

falling ill. " Our data suggests that there is a narrow therapeutic margin

and that consistent use of as little as 7.5 g/day may be hazardous, "

report the authors, who plan to investigate that issue in a future study. Their

data also suggest, they say, that there is no chronic form of acetaminophen

injury, rather, a threshold of safety that, when breached, has devastating

results.

Elsewhere in the world, unintentional overdosing is less common than

intentional, so, the authors report, " one of the most alarming findings in

our study was that unintentional acetaminophen overdose accounted for 50

percent of our cases. "

Although the incidence of acetaminophen overdose is still low compared to the

millions of tablets consumed on a daily basis, the findings of this study were

startling and led the authors to propose changes in the way acetaminophen is

sold.

" Efforts to limit over-the-counter package size and to restrict the

prescription of narcotic-acetaminophen combinations (or to separate the

narcotic from the acetaminophen) may be necessary to reduce the incidence of

this increasingly recognized but preventable cause of acute liver failure in

the United States, " they conclude.

23

received liver transplants! Too bad

there isn’t more press about this.

Those 23 cases might have been avoided. I get mad every time I see a Tylenol

commercial, I know it’s a good product, but more warnings are needed.

Barb in Texas Together in the

fight, whatever it takes.

Son Ken (31) UC 91 PSC

99