Acute liver failure and self-medication

INTRODUCTION: Not responsible self-medication refers to drug use in high doses without rational indication and often associated with alcohol abuse. It can lead to liver damage and drug interactions, and may cause liver failure. AIM: To warn about how the practice of self-medication can be responsible for acute liver failure. METHOD: Were used the Medline via PubMed, Cochrane Library, SciELO and Lilacs, and additional information on institutional sites of interest crossing the headings acute liver failure [tiab] AND acetaminophen [tiab]; self-medication [tiab] AND acetaminophen [tiab]; acute liver failure [tiab] AND dietary supplements [tiab]; self-medication [tiab] AND liver failure [tiab] and self-medication [tiab] AND green tea [tiab]. In Lilacs and SciELO used the descriptor self medication in Portuguese and Spanish. From total surveyed were selected 27 articles and five sites specifically related to the purpose of this review. CONCLUSIONS: Legislation and supervision disabled and information inaccessible to people, favors the emergence of cases of liver failure drug in many countries. In the list of released drugs that deserve more attention and care, are some herbal medicines used for the purpose of weight loss, and acetaminophen. It is recommended that institutes of health intensify supervision and better orient their populations on drug seemingly harmless, limiting the sale of products or requiring a prescription for release them.

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Obesity Therapy: How and Why?

Current Medicinal Chemistry ◽

10.2174/0929867326666190124121725 ◽

2020 ◽

Vol 27 (2) ◽

pp. 174-186 ◽

Cited By ~ 9

Author(s):

Sara Paccosi ◽

Barbara Cresci ◽

Laura Pala ◽

Carlo Maria Rotella ◽

Astrid Parenti

Keyword(s):

Weight Loss ◽

Lifestyle Modification ◽

Herbal Medicines ◽

The Internet ◽

Obese Patients ◽

Self Medication ◽

Pharmacological Management ◽

Regulatory Standards ◽

Meta Analyses ◽

Obesity Drugs

Background: Obesity represents the second preventable mortality cause worldwide, and is very often associated with type 2 Diabetes Mellitus (T2DM). The first line treatment is lifestyle modification to weight-loss, but for those who fail to achieve the goal or have difficulty in maintaining achieved results, pharmacological treatment is needed. Few drugs are available today, because of their side effects. Objective: We aim to review actual pharmacological management of obese patients, highlighting differences between Food and Drug Administration - and European Medicine Agency-approved molecules, and pointing out self-medications readily obtainable and widely distributed. Methods: Papers on obesity, weight loss, pharmacotherapy, self- medication and diet-aid products were selected using Medline. Research articles, systematic reviews, clinical trials and meta-analyses were screened. Results: Anti-obesity drugs with central mechanisms, such as phentermine and lorcaserin, are available in USA, but not in Europe. Phentermine/topiramate and naltrexone/bupropion combinations are now available, even though the former is still under investigation from EMA. Orlistat, with peripheral mechanisms, represents the only drug approved for weight reduction in adolescents. Liraglutide has been approved at higher dose for obesity. Anti-obesity drugs, readily obtainable from the internet, include crude-drug products and supplements for which there is often a lack of compliance to national regulatory standards. Conclusion: Mechanisms of weight loss drugs include the reduction of energy intake or the increase in energy expenditure and sense of satiety as well as the decrease of hunger or the reduction in calories absorption. Few drugs are approved, and differences exist between USA and Europe. Moreover, herbal medicines and supplements often sold on the internet and widely used by obese patients, present a risk of adverse effects.

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COVID-19: a fatal case of acute liver failure associated with SARS-CoV-2 infection in pre-existing liver cirrhosis

BMC Infectious Diseases ◽

10.1186/s12879-021-06605-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jana Ihlow ◽

Alexander Seelhoff ◽

Victor M. Corman ◽

Achim D. Gruber ◽

Simon Dökel ◽

...

Keyword(s):

Liver Failure ◽

Acute Liver Failure ◽

Liver Damage ◽

Cathepsin L ◽

Fatal Case ◽

Clinical Signs ◽

Angiotensin Converting Enzyme 2 ◽

Severe Liver Damage ◽

Severe Jaundice ◽

Transmembrane Serine Protease

Abstract Background The detection of severe acute respiratory syndrome coronavirus (SARS-CoV-2) is challenging, particularly in post-mortem human tissues. However, there is increasing evidence for viral SARS-CoV-2 manifestation in non-respiratory tissues. In this context, it is a current matter of debate, whether SARS-CoV-2 shows hepatotropism. Case presentation Here, we report a case of an 88-year-old women with massive SARS-CoV-2 viremia, severe jaundice and clinical signs of an acute hepatitis, who died within a few days from an acute liver failure without showing any clinical signs of pneumonia. Autopsy revealed a severe chronic and acute liver damage with bile duct infestation by SARS-CoV-2 that was accompanied by higher expressions of angiotensin-converting enzyme-2 (ACE2), Cathepsin L and transmembrane serine protease 2 (TMPRSS2). Conclusion Our findings indicate an enhanced biliary susceptibility to viral infection with SARS-CoV-2, that might have resulted from pre-existing severe liver damage. Furthermore, our findings emphasize the differential diagnosis of coronavirus disease 2019 (COVID-19)-associated liver failure in the clinical setting of an inexplicable jaundice.

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Persistence of Parvovirus B19 in liver from transplanted patients with acute liver failure

Future Microbiology ◽

10.2217/fmb-2019-0224 ◽

2020 ◽

Vol 15 (5) ◽

pp. 307-317 ◽

Cited By ~ 1

Author(s):

Arthur DR Alves ◽

Juliana G Melgaço ◽

Rita de Cássia NC Garcia ◽

Jessica V Raposo ◽

Vanessa S de Paula ◽

...

Keyword(s):

Liver Transplantation ◽

Liver Failure ◽

Acute Liver Failure ◽

Liver Damage ◽

Parvovirus B19 ◽

Transcript Expression ◽

Mrna Transcript ◽

Serological Tests ◽

Infected Liver

Aim: In this study, we investigated the presence of B19V in liver tissues from patients with acute liver failure (ALF) and evaluated the viral activity in infected liver. Methods: Serum and liver samples from 30 patients who underwent liver transplantation for ALF were investigated for B19V infection by real-time PCR, serological tests and examination of B19V mRNA (transcript) expression in the liver. Results: The serum and liver samples from seven patients were B19V DNA positive (103–105 copies/ml). Most of them presented detectable anti-B19V IgG, indicating persistent infection. B19V mRNA was detected in all patients, demonstrating intra-hepatic replication. Conclusion: B19V infection of the liver during the course of non-A-E ALF suggested a role of B19V, which produced the worst outcome in co-infected patients and in patients with cryptogenic ALF, in liver damage.

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Liver stiffness measured by acoustic radiation force impulse elastography reflects the severity of liver damage and prognosis in patients with acute liver failure

Hepatology Research ◽

10.1111/hepr.12389 ◽

2014 ◽

Vol 45 (5) ◽

pp. 571-577 ◽

Cited By ~ 11

Author(s):

Hidekatsu Kuroda ◽

Keisuke Kakisaka ◽

Takayoshi Oikawa ◽

Mio Onodera ◽

Yasuhiro Miyamoto ◽

...

Keyword(s):

Liver Failure ◽

Acute Liver Failure ◽

Liver Damage ◽

Acoustic Radiation ◽

Liver Stiffness ◽

Radiation Force ◽

Acoustic Radiation Force ◽

Acoustic Radiation Force Impulse

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The Use of Herbal Medicines for the Prevention of Glucocorticoid-Induced Osteoporosis

Frontiers in Endocrinology ◽

10.3389/fendo.2021.744647 ◽

2021 ◽

Vol 12 ◽

Author(s):

Leiming Zhang ◽

Xiaoli Li ◽

Tianhao Ying ◽

Tian Wang ◽

Fenghua Fu

Keyword(s):

Side Effects ◽

Glycyrrhizic Acid ◽

Herbal Medicines ◽

Cochrane Library ◽

Hormone Synthesis ◽

Increased Risk ◽

Anti Inflammatory ◽

High Doses ◽

Risk Of Treatment ◽

Plant Sources

Glucocorticoids are drugs that are widely used to suppress inflammation and the activation of the immune system. However, the prolonged use or at high doses of glucocorticoid can result in adverse side effects including osteoporosis, bone loss, and an increased risk of fracture. A number of compounds derived from natural plant sources have been reported to exert anti-inflammatory activity by interacting with the glucocorticoid receptor (GR), likely owing to their chemical similarity to glucocorticoids, or by regulating GR, without a concomitant risk of treatment-related side effects such as osteoporosis. Other herbal compounds can counteract the pathogenic processes underlying glucocorticoid-induced osteoporosis (GIOP) by regulating homeostatic bone metabolic processes. Herein, we systematically searched the PubMed, Embase, and Cochrane library databases to identify articles discussing such compounds published as of May 01, 2021. Compounds reported to exert anti-inflammatory glucocorticoid-like activity without inducing GIOP include escin, ginsenosides, and glycyrrhizic acid, while compounds reported to alleviate GIOP by improving osteoblast function or modulating steroid hormone synthesis include tanshinol and icariin.

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Acute liver failure induced by green tea extracts: Case report and review of the literature

Liver Transplantation ◽

10.1002/lt.21021 ◽

2006 ◽

Vol 12 (12) ◽

pp. 1892-1895 ◽

Cited By ~ 96

Author(s):

Michele Molinari ◽

Kymberly D.S. Watt ◽

Thomas Kruszyna ◽

Rebecca Nelson ◽

Mark Walsh ◽

...

Keyword(s):

Case Report ◽

Liver Failure ◽

Acute Liver Failure ◽

Green Tea ◽

Review Of The Literature

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Effects of larazotide acetate, a tight junction regulator, on the liver and intestinal damage in acute liver failure in rats

Human & Experimental Toxicology ◽

10.1177/09603271211058882 ◽

2021 ◽

pp. 096032712110588

Author(s):

Ali Riza Caliskan ◽

Mehmet Gul ◽

Ismet Yılmaz ◽

Baris Otlu ◽

Nuray Uremis ◽

...

Keyword(s):

Epithelial Cells ◽

Liver Failure ◽

Acute Liver Failure ◽

Liver Damage ◽

Light And Electron Microscopy ◽

Intestinal Damage ◽

Intestinal Histology ◽

Oral Gavage ◽

Significant Difference ◽

Serum Ammonia

Background and Aim The epithelial cells are the strongest determinants of the physical intestinal barrier. Tight junctions (TJs) hold the epithelial cells together and allow for selective paracellular permeability. Larazotide acetate (LA) is a synthetic octapeptide that reduces TJ permeability by blocking zonulin receptors. In this study, we aimed to investigate the effects of LA, a TJ regulator, on the liver and intestinal histology in the model of acute liver failure (ALF) in rats. Materials and Methods The thioacetamide (TAA) group received intraperitoneal (ip) injections of 300 mg/kg TAA for 3 days. The TAA+LA(dw) (drinking water) group received prophylactic 0.01 mg/mL LA orally for 7 days before the first dose of TAA. The LA(dw) group received 0.01 mg/mL LA orally. The TAA + LA(g) (gavage) group received prophylactic 0.01 mg/mL LA via oral gavage for 7 days before the first dose of TAA. The LA(g) group received 0.01 mg/mL LA via oral gavage. While liver tissue was evaluated only with light microscopy, intestinal samples were examined with light and electron microscopy. Results Serum ammonia, AST, and ALT levels in the TAA group were significantly higher than in control groups (all p < 0.01). Serum ALT levels in the TAA + LA(dw) group were significantly lower than in the TAA group ( p < 0.05). However, serum ammonia and ALT levels did not differ between the TAA and other groups. Serious liver damage in the TAA group was accompanied by marked intestinal damage. There was no significant difference between the TAA and TAA + LA(dw) groups and TAA and TAA + LA(g) groups for liver damage scores. However, intestinal damage scores significantly decreased in the TAA + LA(dw) group compared to the TAA group. In the TAA + LA(dw) group, fusion occurred between the surface epithelial cells of neighboring villi and connecting regions formed as epithelial bridges between the villi. Conclusion Our findings suggest that LA reduced intestinal damage by acting on TJs in the TAA-induced ALF model in rats.

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Novel Therapeutic Approaches Against Acetaminophen-induced Liver Injury and Acute Liver Failure

Toxicological Sciences ◽

10.1093/toxsci/kfaa002 ◽

2020 ◽

Vol 174 (2) ◽

pp. 159-167 ◽

Cited By ~ 9

Author(s):

Hartmut Jaeschke ◽

Jephte Y Akakpo ◽

David S Umbaugh ◽

Anup Ramachandran

Keyword(s):

Liver Injury ◽

Liver Failure ◽

Acute Liver Failure ◽

Kinase Inhibitor ◽

Antioxidant Activities ◽

Clinical Problem ◽

Therapeutic Window ◽

Cytochrome P450 Enzymes ◽

Protective Strategies ◽

High Doses

Abstract Liver injury and acute liver failure caused by acetaminophen (APAP, N-acetyl-p-aminophenol, paracetamol) overdose is a significant clinical problem in most western countries. The only clinically approved antidote is N-acetylcysteine (NAC), which promotes the recovery of hepatic GSH. If administered during the metabolism phase, GSH scavenges the reactive metabolite N-acetyl-p-benzoquinone imine. More recently, it was shown that NAC can also reconstitute mitochondrial GSH levels and scavenge reactive oxygen/peroxynitrite and can support mitochondrial bioenergetics. However, NAC has side effects and may not be efficacious after high overdoses. Repurposing of additional drugs based on their alternate mechanisms of action could be a promising approach. 4-Methylpyrazole (4MP) was shown to be highly effective against APAP toxicity by inhibiting cytochrome P450 enzymes in mice and humans. In addition, 4MP is a potent c-Jun N-terminal kinase inhibitor expanding its therapeutic window. Calmangafodipir (CMFP) is a SOD mimetic, which is well tolerated in patients and has the potential to be effective after severe overdoses. Other drugs approved for humans such as metformin and methylene blue were shown to be protective in mice at high doses or at human therapeutic doses, respectively. Additional protective strategies such as enhancing antioxidant activities, Nrf2-dependent gene induction and autophagy activation by herbal medicine components are being evaluated. However, at this point, their mechanistic insight is limited, and the doses used are high. More rigorous mechanistic studies are needed to advance these herbal compounds. Nevertheless, based on recent studies, 4-methylpyrazole and calmangafodipir have realistic prospects to become complimentary or even alternative antidotes to NAC for APAP overdose.

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