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Failure of Physicians to Recognize Acetaminophen Hepatotoxicity in Chronic Alcoholics

Failure of Physicians to Recognize Acetaminophen Hepatotoxicity in Chronic Alcoholics Abstract We encountered six alcoholic patients with severe acetaminophen hepatotoxicity during a 2-year period. All patients had marked elevations of aminotransferases and sometimes remarkably high prothrombin times at, or shortly after, presentation. In five of six cases the diagnosis was missed by the physicians initially caring for the patient. The apparent reasons for the missed diagnosis were insufficient history regarding the use of acetaminophen, an inappropriate reliance on blood acetaminophen levels, and lack of knowledge regarding typical aminotransferase elevations in alcoholic hepatitis vs acetaminophen toxicity. The initial clinical presentation of acetaminophen hepatotoxicity in chronic alcoholics is easily recognized clinically and is distinct from acetaminophen hepatotoxicity in suicide ingestions and from alcoholic hepatitis. Internists and other physicians should be aware of this entity and rely on the clinical picture and the history of acetaminophen use to confirm the diagnosis. (Arch Intern Med. 1991;151:1189-1191) References 1. Black M. Acetaminophen hepatotoxicity . Ann Rev Med. 1984;35:577-593.Crossref 2. Emby DJ, Fraser BN. Hepatotoxicity of paracetamol enhanced by ingestion of alcohol: report of two cases . S Afr Med J. 1977;87:299-301. 3. Barker JD, DeCarle DJ, Anuras S. Chronic excessive acetaminophen use and liver damage . Ann Intern Med. 1977;87:299-301.Crossref 4. Goldfinger R, Ahmed KS, Pitchumoni CS, Weseley SA. Concomitant alcohol and drug abuse enhancing acetaminophen toxicity . Am J Gastroenterol. 1978;70:385-388. 5. LaBrecque DR, Mitros FA. Increased hepatotoxicity of acetaminophen in the alcoholic . Gastroenterology. 1980;78:1310. Abstract. 6. McClain CJ, Kromhout JP, Peterson FJ, Holtzman JL. Potentiation of acetaminophen hepatotoxicity by alcohol . JAMA. 1980;244:251-253.Crossref 7. Light H, Seeff LB, Zimmerman HJ. Apparent potentiation of acetaminophen hepatotoxicity by alcohol . Ann Intern Med. 1980;92:511.Crossref 8. Gerger MA, Kaufmann H, Klion F, Alpert LI. Acetaminophen associated hepatic injury: report of two cases showing unusual portal tract reaction . Hum Pathol. 1980;11:37-42.Crossref 9. Johnson MW, Friedman PA, Mitch WE. Alcoholism non-prescription drugs and hepatotoxicity: the risk from unknown acetaminophen ingestion . Am J Gastroenterol. 1981;76:530-533. 10. Black M, Cornell JF, Rabin L, Shackter N. Late presentation of acetaminophen hepatotoxicity . Dig Dis Sci. 1982;27:370-374.Crossref 11. Levinson M. Ulcer, back pain, and jaundice in an alcoholic . Hosp Pract. 1983;18:48N, 48S. 12. Himmelstein DU, Woolhandler SJ, Adler RD. Elevated SGOT/SGPT ratio in alcoholic patients with acetaminophen hepatotoxicity. Am J Gastroenterol. 1984;79:718-720. 13. Fleckenstein JL. Nyquil and acute hepatic necrosis . N Engl J Med. 1985;313:48. 14. Leist MH, Gluskin LE, Payne JA. Enhanced toxicity of acetaminophen in alcoholics: report of three cases . J Clin Gastroenterol. 1985;7:55-59.Crossref 15. Seeff LB, Cuccherini BA, Zimmerman J, Adler E, Benjamin S. Hepatotoxicity in alcoholics: a therapeutic misadventure . Ann Intern Med. 1986;104:399-404.Crossref 16. Lieber CS. Biochemical and molecular basis of alcohol-induced injury to liver and other tissues . N Engl J Med. 1988;319:1639-1650.Crossref 17. Clark R, Thompson RPH, Borirakchanyavat V, et al. Hepatic damage and death from overdose of parocetanol . Lancet. 1973;1:66-69.Crossref 18. Sabesin SM, Hawkins HC, Bertram PD, Mann JA, Peace RJ. Alcoholic hepatitis . Gastroenterology. 1978;74:276-286. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Failure of Physicians to Recognize Acetaminophen Hepatotoxicity in Chronic Alcoholics

Archives of Internal Medicine , Volume 151 (6) – Jun 1, 1991

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Publisher
American Medical Association
Copyright
Copyright © 1991 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1991.00400060113019
Publisher site
See Article on Publisher Site

Abstract

Abstract We encountered six alcoholic patients with severe acetaminophen hepatotoxicity during a 2-year period. All patients had marked elevations of aminotransferases and sometimes remarkably high prothrombin times at, or shortly after, presentation. In five of six cases the diagnosis was missed by the physicians initially caring for the patient. The apparent reasons for the missed diagnosis were insufficient history regarding the use of acetaminophen, an inappropriate reliance on blood acetaminophen levels, and lack of knowledge regarding typical aminotransferase elevations in alcoholic hepatitis vs acetaminophen toxicity. The initial clinical presentation of acetaminophen hepatotoxicity in chronic alcoholics is easily recognized clinically and is distinct from acetaminophen hepatotoxicity in suicide ingestions and from alcoholic hepatitis. Internists and other physicians should be aware of this entity and rely on the clinical picture and the history of acetaminophen use to confirm the diagnosis. (Arch Intern Med. 1991;151:1189-1191) References 1. Black M. Acetaminophen hepatotoxicity . Ann Rev Med. 1984;35:577-593.Crossref 2. Emby DJ, Fraser BN. Hepatotoxicity of paracetamol enhanced by ingestion of alcohol: report of two cases . S Afr Med J. 1977;87:299-301. 3. Barker JD, DeCarle DJ, Anuras S. Chronic excessive acetaminophen use and liver damage . Ann Intern Med. 1977;87:299-301.Crossref 4. Goldfinger R, Ahmed KS, Pitchumoni CS, Weseley SA. Concomitant alcohol and drug abuse enhancing acetaminophen toxicity . Am J Gastroenterol. 1978;70:385-388. 5. LaBrecque DR, Mitros FA. Increased hepatotoxicity of acetaminophen in the alcoholic . Gastroenterology. 1980;78:1310. Abstract. 6. McClain CJ, Kromhout JP, Peterson FJ, Holtzman JL. Potentiation of acetaminophen hepatotoxicity by alcohol . JAMA. 1980;244:251-253.Crossref 7. Light H, Seeff LB, Zimmerman HJ. Apparent potentiation of acetaminophen hepatotoxicity by alcohol . Ann Intern Med. 1980;92:511.Crossref 8. Gerger MA, Kaufmann H, Klion F, Alpert LI. Acetaminophen associated hepatic injury: report of two cases showing unusual portal tract reaction . Hum Pathol. 1980;11:37-42.Crossref 9. Johnson MW, Friedman PA, Mitch WE. Alcoholism non-prescription drugs and hepatotoxicity: the risk from unknown acetaminophen ingestion . Am J Gastroenterol. 1981;76:530-533. 10. Black M, Cornell JF, Rabin L, Shackter N. Late presentation of acetaminophen hepatotoxicity . Dig Dis Sci. 1982;27:370-374.Crossref 11. Levinson M. Ulcer, back pain, and jaundice in an alcoholic . Hosp Pract. 1983;18:48N, 48S. 12. Himmelstein DU, Woolhandler SJ, Adler RD. Elevated SGOT/SGPT ratio in alcoholic patients with acetaminophen hepatotoxicity. Am J Gastroenterol. 1984;79:718-720. 13. Fleckenstein JL. Nyquil and acute hepatic necrosis . N Engl J Med. 1985;313:48. 14. Leist MH, Gluskin LE, Payne JA. Enhanced toxicity of acetaminophen in alcoholics: report of three cases . J Clin Gastroenterol. 1985;7:55-59.Crossref 15. Seeff LB, Cuccherini BA, Zimmerman J, Adler E, Benjamin S. Hepatotoxicity in alcoholics: a therapeutic misadventure . Ann Intern Med. 1986;104:399-404.Crossref 16. Lieber CS. Biochemical and molecular basis of alcohol-induced injury to liver and other tissues . N Engl J Med. 1988;319:1639-1650.Crossref 17. Clark R, Thompson RPH, Borirakchanyavat V, et al. Hepatic damage and death from overdose of parocetanol . Lancet. 1973;1:66-69.Crossref 18. Sabesin SM, Hawkins HC, Bertram PD, Mann JA, Peace RJ. Alcoholic hepatitis . Gastroenterology. 1978;74:276-286.

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Jun 1, 1991

References