Dosage of N-acetyl cysteine in acute liver Failure not related to acetaminophen

Background.Acute liver failure can result from acetaminophen overdose, viral infection, toxins, and other disease conditions. Liver transplant is available in limited fashion and the criteria are strict as to who should get an available liver. N- Acetyl Cysteine (NAC) has been used in non-acetaminophen induced liver failure with success. Here we report a case of acute liver failure from cocaethylene that was reversed with NAC along with other medical therapy.Case Presentation.A 50-year-old female patient presented to the Emergency Department (ED) with a two-day history of coffee ground vomiting and hematemesis. She reported occasional substance abuse and heavy alcoholism. She reported shortness of breath and chest pain from the recurrent forceful vomiting. The rest of the review of systems was unremarkable except a fall from intoxication. Physical examination revealed anicteric conjunctiva and nontender abdomen and her vital signs were within normal limits. Initial blood work revealed acute liver and renal failure. The patient was started with general medical management and liver transplant service rejected the case due to active substance abuse. She underwent brief hemodialysis and was started on NAC. Over the course of her hospital stay her liver function and kidney function improved significantly and patient was discharged to home.Conclusion.In cases where liver transplant is not an option for various reasons including active substance abuse, a trial of N-Acetyl Cysteine may be beneficial and should be considered in the Emergency Department.

Download Full-text

Sa1483 N-ACETYL CYSTEINE (NAC) IN NON-ACETAMINOPHEN INDUCED ACUTE LIVER FAILURE: A SYSTEMATIC REVIEW AND META-ANALYSIS

Gastroenterology ◽

10.1016/s0016-5085(20)33928-7 ◽

2020 ◽

Vol 158 (6) ◽

pp. S-1307

Author(s):

Shahab R. Khan ◽

Veeraraghavan Meyyur Aravamudan ◽

Babu P. Mohan ◽

Saurabh Chandan ◽

Rajesh Kotagiri ◽

...

Keyword(s):

Systematic Review ◽

Liver Failure ◽

Acute Liver Failure ◽

Meta Analysis ◽

Acetyl Cysteine

Download Full-text

N-Acetyl cysteine in non-acetaminophen pediatric acute liver failure: Recent evidence !

Indian Pediatrics ◽

10.1007/s13312-013-0246-2 ◽

2013 ◽

Vol 50 (10) ◽

pp. 972-972

Author(s):

Manish Sharma ◽

Nishant Verma

Keyword(s):

Liver Failure ◽

Acute Liver Failure ◽

Acetyl Cysteine ◽

Pediatric Acute Liver Failure

Download Full-text

Rodenticide-induced acute liver failure – Uncommon presentation of commonly available poison

Tropical Doctor ◽

10.1177/00494755211031019 ◽

2021 ◽

pp. 004947552110310

Author(s):

Saurabh Dawra ◽

Ankit Kumar ◽

Dharmender Kumar ◽

Balakrishnan Ari ◽

Sharad Srivastava ◽

...

Keyword(s):

Liver Transplantation ◽

Liver Failure ◽

Acute Liver Failure ◽

Paracetamol Poisoning ◽

Agrarian Economy ◽

Resource Limited ◽

Uncommon Presentation ◽

Metal Phosphides ◽

Severe Intoxication ◽

Acetyl Cysteine

Rodenticide or ‘rat poison’ is easily available in a predominantly agrarian economy such as India. Metal phosphides or yellow phosphorous are two common rodenticides. Acute liver failure caused by accidental or suicidal poisoning with rodenticides has been infrequently reported in literature. Liver transplantation offers the best chances of survival in severe intoxication. However, the availability of liver transplantation in resource-limited settings presents a challenge. N-acetyl cysteine has been successfully used in paracetamol poisoning. Its use in rodenticide-induced acute liver failure is not so well known. We report three cases of rodenticide-related acute liver failure, one of them being a pregnant lady. All three patients were given N-acetyl cysteine and two patients improved. It is possible that the administration of N-acetyl cysteine contributed to the improvement in these two.

Download Full-text

Design of anti-inflammatory heparan sulfate to protect against acetaminophen-induced acute liver failure

Science Translational Medicine ◽

10.1126/scitranslmed.aav8075 ◽

2020 ◽

Vol 12 (535) ◽

pp. eaav8075 ◽

Cited By ~ 8

Author(s):

Katelyn Arnold ◽

Yongmei Xu ◽

Erica M. Sparkenbaugh ◽

Miaomiao Li ◽

Xiaorui Han ◽

...

Keyword(s):

Liver Failure ◽

Acute Liver Failure ◽

Heparan Sulfate ◽

Core Protein ◽

Lethal Dose ◽

The United States ◽

Sterile Inflammation ◽

Drug Induced ◽

Apap Overdose ◽

Acetyl Cysteine

Acetaminophen/paracetamol (APAP) overdose is the leading cause of drug-induced acute liver failure (ALF) in the United States and Europe. The progression of the disease is attributed to sterile inflammation induced by the release of high mobility group box 1 (HMGB1) and the interaction with receptor for advanced glycation end products (RAGE). A specific, effective, and safe approach to neutralize the proinflammatory activity of HMGB1 is highly desirable. Here, we found that a heparan sulfate (HS) octadecasaccharide (18-mer-HP or hepatoprotective 18-mer) displays potent hepatoprotection by targeting the HMGB1/RAGE axis. Endogenous HS proteoglycan, syndecan-1, is shed in response to APAP overdose in mice and humans. Furthermore, purified syndecan-1, but not syndecan-1 core protein, binds to HMGB1, suggesting that HMGB1 binds to HS polysaccharide side chains of syndecan-1. Last, we compared the protection effect between 18-mer-HP and N-acetyl cysteine, which is the standard of care to treat APAP overdose. We demonstrated that 18-mer-HP administered 3 hours after a lethal dose of APAP is fully protective; however, the treatment of N-acetyl cysteine loses protection. Therefore, 18-mer-HP may offer a potential therapeutic advantage over N-acetyl cysteine for late-presenting patients. Synthetic HS provides a potential approach for the treatment of APAP-induced ALF.

Download Full-text