scholarly journals The Role of Acetyl Cysteine in Cocaethylene (Non-Acetaminophen) Acute Liver Failure

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Getaw Worku Hassen ◽  
Amaninder Dhaliwal ◽  
Catherine Ann Jenninigs ◽  
Hossein Kalantari
Keyword(s):  
Emergency Department ◽  
Substance Abuse ◽  
Liver Failure ◽  
Liver Transplant ◽  
Acute Liver Failure ◽  
Active Substance ◽  
Vital Signs ◽  
Normal Limits ◽  
History Of ◽  
Acetyl Cysteine

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.

scholarly journals Skull Base Osteomyelitis in the Emergency Department: A Case Report

2011 ◽  
Vol 2011 ◽  
pp. 1-3 ◽  
Author(s):  
Mustafa Burak Sayhan ◽  
Cemil Kavalci ◽  
Ozgur Sogüt ◽  
Eylem Sezenler
Keyword(s):  
Emergency Department ◽  
Skull Base ◽  
Vital Signs ◽  
Morbidity And Mortality ◽  
Cranial Computed Tomography ◽  
Lytic Lesion ◽  
High Morbidity ◽  
Skull Base Osteomyelitis ◽  
Normal Limits ◽  
History Of

Skull base osteomyelitis (SBO) is a rare clinical presentation and usually occurs as a complication of trauma or sinusitis. A 5-year-old child presented to the emergency department with a three-week history of fever associated with drowsiness and left parietal headache, and a week's history of swelling on the left frontoparietal soft tissue. He had suffered a penetrating scalp injury four month ago. On physical examination, there was a tender swelling with purulent stream on the lateral half of his scalp. His vital signs are within normal limits. Plain X-ray of the skull showed a lytic lesion on the left frontoparietal bone. A cranial computed tomography (CT) scan demonstrated a large subgaleal abscess at the left frontoparietal region. SBO possesses a high morbidity and mortality; therefore, prompt diagnosis and appropriate treatment are mandatory to prevent further complications and to reduce morbidity and mortality significantly.

scholarly journals Experiences of substance-using suicidal males who present frequently to the emergency department

CJEM ◽  
2008 ◽  
Vol 10 (04) ◽  
pp. 339-346 ◽  
Author(s):  
Julia M. Spence ◽  
Yvonne Bergmans ◽  
Carol Strike ◽  
Paul S. Links ◽  
Jeffrey S. Ball ◽  
...  
Keyword(s):  
Emergency Department ◽  
Substance Abuse ◽  
Suicidal Behaviour ◽  
Group Identification ◽  
High Risk Group ◽  
Staff Members ◽  
Care Workers ◽  
History Of ◽  
Seeking Help ◽  
Iterative Coding

ABSTRACTObjective:This qualitative study investigated the repeated use of the emergency department (ED) by men with a history of suicidal behaviour and substance abuse to understand the needs and barriers to care for this high-risk group. Identification of common themes from interviews with patients and health care workers can serve as a basis for improved ED-based interventions.Methods:Using semistructured interviews, patients, ED staff and family physicians were asked about needs of the aformentioned group. Twenty-five patients were interviewed and completed questionnaires regarding their substance use, aggression, parasuicidal behaviour, alexithymia and childhood trauma. In addition, 27 staff members were interviewed. Interviews were tape-recorded, transcribed and qualitatively analyzed using an iterative coding process.Results:Of the 25 patients, 23 (96%) had a mood or anxiety disorder and 18 (75%) had borderline personality disorder. One-half of the patients scored high and another quarter scored moderate on alexithymia testing. The ED was viewed as a last resort despite seeking help. Frustration was felt by both patients and staff regarding difficult communication, especially during an acute crisis.Conclusion:The ED plays an important role in the provision of care for men with recurrent suicidal behaviour and substance abuse. Some of the diagnoses and problems faced by these patients are beyond the purview of the ED; however, staff can identify mutual goals for crisis interventions, allow for frequent communication and seek to de-escalate situations through the validation of the stress patients are experiencing.

scholarly journals A Rare Case of Vault Angiofibroma

2021 ◽  
Vol 10 (16) ◽  
pp. 1177-1178
Author(s):  
Jayanthi R. ◽  
Iysverya G.T ◽  
Nishanthi Chandru
Keyword(s):  
Female Patient ◽  
Rare Case ◽  
Vital Signs ◽  
Vaginal Vault ◽  
Vaginal Examination ◽  
Speculum Examination ◽  
Normal Limits ◽  
Surgical Menopause ◽  
History Of ◽  
Foul Smell

A 52-year-old female patient, para 2 live 2, who attained surgical menopause 10 years back, presented to the outpatient department (OPD) with complaints of white discharge per vagina for 6 months, which was watery in consistency and was not associated with foul smell or itching vulva. She had history of hysterectomy done for fibroid uterus 10 years back. On examination, she was afebrile and vital signs were within normal limits. Per abdomen examination, was normal, while, per speculum examination revealed a watery discharge per vaginum. The per vaginal examination revealed a firm, non-tender, globular mass felt arising from the vaginal vault and the mass did not bleed on touch. A globular mass of size 3 x 4 cms, pinkish white in colour, was seen occupying the whole of the vaginal vault with curdy white precipitates in the vaginal rugosities as well as over the mass.

scholarly journals PP031—Drug-associated acute liver failure leading to registration for transplantation in france from the study of acute liver transplant (SALT)

2013 ◽  
Vol 35 (8) ◽  
pp. e27
Author(s):  
E. Gulmez ◽  
D. Larrey ◽  
G.-P. Pageaux ◽  
J. Jové ◽  
R. Lassalle ◽  
...  
Keyword(s):  
Liver Failure ◽  
Liver Transplant ◽  
Acute Liver Failure

Successful ABO‐incompatible living donor liver transplant for acute liver failure secondary to Hodgkin's Lymphoma in a child

2020 ◽  
Vol 24 (7) ◽  
Author(s):  
Lliam Brannigan ◽  
Harriet R. Etheredge ◽  
Marisa Beretta ◽  
Despina Demopoulos ◽  
Kate G. Bennett ◽  
...  
Keyword(s):  
Liver Failure ◽  
Liver Transplant ◽  
Acute Liver Failure ◽  
Hodgkin’S Lymphoma ◽  
Living Donor ◽  
Hodgkin's Lymphoma ◽  
Donor Liver ◽  
Living Donor Liver Transplant ◽  
Donor Liver Transplant

scholarly journals Acute Liver Failure with Diffuse Liver Metastasis from Breast Cancer, Not Detected by Computed Tomography: 2 Case Reports

2018 ◽  
Vol 11 (3) ◽  
pp. 699-704 ◽  
Author(s):  
Takatsugu Ogata ◽  
Yuichiro Kikawa ◽  
Misato Ogata ◽  
Hironaga Satake ◽  
Yukimasa Hatachi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Computed Tomography ◽  
Liver Metastasis ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Hepatic Failure ◽  
Poor Prognosis ◽  
Alcoholic Hepatitis ◽  
Case Reports ◽  
History Of

Diffuse liver metastasis is a rare pattern of liver metastasis that is associated with hepatic failure and poor prognosis. We experienced 2 cases of acute liver failure due to diffuse metastasis that could not be detected using computed tomography. In case 1, it was difficult to differentiate diffuse metastasis from alcoholic hepatitis. In case 2, it was difficult to diagnose diffuse liver metastasis because the patient had no history of malignancy. When liver enzyme levels are elevated, it is necessary to consider liver metastasis as a potential cause, regardless of computed tomography findings.

scholarly journals Acute Liver Failure due to Wilson Disease: Eight Years of the National Liver Transplant Program in Uruguay

2019 ◽  
Vol 18 (1) ◽  
pp. 187-192 ◽  
Author(s):  
Victoria Mainardi ◽  
Karina Rando ◽  
Marcelo Valverde ◽  
Daniela Olivari ◽  
Jorge Castelli ◽  
...  
Keyword(s):  
Liver Failure ◽  
Liver Transplant ◽  
Acute Liver Failure ◽  
Wilson Disease ◽  
Transplant Program

scholarly journals Acute liver failure in children: observations in Vitória, Espírito Santo State, Brazil

2002 ◽  
Vol 35 (5) ◽  
pp. 483-486 ◽  
Author(s):  
Sandra F. Moreira-Silva ◽  
Diana O. Frauches ◽  
Alba L. Almeida ◽  
Haydée F.M.S. Mendonça ◽  
Fausto Edmundo L. Pereira
Keyword(s):  
Liver Failure ◽  
Acute Liver Failure ◽  
Age Differences ◽  
Northeastern Brazil ◽  
Biochemical Tests ◽  
Fatal Disease ◽  
History Of ◽  
Sporadic Hepatitis ◽  
The Mean ◽  
Acute Sporadic Hepatitis

In this communication we report 46 cases of acute liver failure in children diagnosed at the Hospital Infantil Nossa Senhora da Glória in Vitória, E Santo. Serology for IgM anti-HAV, IgM anti-HBc, HbsAg, anti-HCV and biochemical tests were performed in all cases in a routine laboratory. The M/F ratio was 1.1:1 and the mean age was 4.7±3.2 years, without gender difference. Anti-HAV IgM+ in 38 (82.6%) cases, anti-HbcIgM+ in two (4.3 %) cases and 6 (13.1%) cases were negative for all viral markers investigated. Anti- HCV+ in one anti-HAV IgM+ case. HbsAg+ in two anti-HbcIgM+ and in two HAVIgM+ cases. Among the six A, B and C negative cases, four (8.6%) did not have the suspected exogenous intoxication. Mortality was 50%, without gender or age differences. These results demonstrate that HAV infection is the main etiology of acute liver failure in children in Brazil, confirming that, although it is a self limited, relatively mild illness, it can cause serious and even fatal disease. The observation of four cases without A, B and C viral markers and no history of exogenous intoxication, agree with the observation of non A-E acute sporadic hepatitis in Northeastern Brazil.

scholarly journals Presentations Related to Acute Paracetamol Intoxication in an Urban Emergency Department in Switzerland

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Natalia Piotrowska ◽  
Jolanta Klukowska-Rötzler ◽  
Beat Lehmann ◽  
Gert Krummrey ◽  
Manuel Haschke ◽  
...  
Keyword(s):  
Emergency Department ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Borderline Personality ◽  
University Hospital ◽  
Vulnerable Groups ◽  
Intentional Group ◽  
Paracetamol Intoxication

Aim. To investigate the characteristics of Emergency Department (ED) presentations due to acute paracetamol intoxication. Methods. Retrospective observational study of patients presenting to the ED of Bern University Hospital between May 1, 2012, and October 31, 2018, due to a paracetamol overdose (defined as intake of >4 g/24 h). Cases were identified using the full-text search of the electronic patient database and were grouped into intentional (suicidal/parasuicidal) and unintentional intoxications (e.g., patient unaware of maximal daily dose). Results. During the study period, 181 cases were included and 143 (79%) of those were intentional. Compared to the patients in the unintentional group, patients in the intentional group were more often female (85% vs 45%, p<0.001) and younger (median age 23.0 vs 43.5 years, p<0.001), more frequently suffered from psychiatric comorbidities (93%, (including 49% with borderline personality disorder) vs 24%, p<0.001), and paracetamol was more often taken as a single dose (80% vs 13%, p<0.001). Although the median daily ingested dose was lower in the unintentional than in the intentional group (8.2 g vs 12.9 g, p<0.001), patients in the unintentional group presented later (29% vs 84% within 24 h of ingestion, p<0.001), included more cases of acute liver failure (nine (24%) vs six (4%), p<0.001), and were more often hospitalised (24% vs 52% treated as outpatients, p=0.002). There were no significant differences between the groups regarding drug-induced liver injury (seven cases (5%) in the intentional and one (3%) in the unintentional group) or fatalities (one in each group). Conclusions. The majority of presentations due to paracetamol poisoning were intentional, most commonly in female patients with borderline personality disorder. Patients with unintentional paracetamol intoxication had worse outcomes with respect to acute liver failure and hospitalisation. Future preventive measures should raise awareness of paracetamol toxicity in the general population and encourage particular attention and frequent follow-ups when prescribing paracetamol for vulnerable groups.

Sign in / Sign up

Export Citation Format

Share Document