Acute liver injury, acute liver failure, Tylenol

Question 1

most common cause of acute liver failure

Answer 1

Tylenol toxicity

Question 2

when do you see Tylenol toxicity?

Answer 2

> 12g within 24 hr period or >250 mg/kg in 24 hrs

Question 3

what risk factors predispose someone to having acetaminophen toxicity

Answer 3

concurrent intake of medications that induce cytochrome P450 enzyme like phenytoin or bactrim.

Chronic alcoholism

Question 4

does acute ingestion of ETOH increase risk for Tylenol toxicity?

Answer 4

No alcohol may be protective as it provides competition to the drug

Question 5

what is the time course for acetaminophen hepatitis?

Answer 5

this is acute in onset and progressive rapidly.

1st 24 hrs of toxicity pt may be asymptomatic or experience AMS or nausea/vomiting. As condition progresses, pt can become lethargic and comatose.

They can develop RUQ pain and oliguria and jaundice and spontaneous bleeding.

Elevation of aminotransferases can happen until 8-12 hrs after ingestion.

Question 6

What happens to AST/ALT in tylenol toxicity?

Answer 6

AST/ALT don’t rise until after 8-12 hrs after ingestion and then it continues to rise for 3-4 days and often exceeds 10K if not treated with N acetylecysteine.

Question 7

Ratio of AST/ALT >2

Answer 7

seen in alcohol hepatitis. AST<300 and rarely >500

Question 8

viral hepatitis AST/ALT levels

Answer 8

rarely > 10X the highest limit.

Question 9

severe pulmonary HTN (right heart failure) can cause hepatic congestion and those labs are:

Answer 9

Total bili <3

AST/ALT are mildly elevated.

Question 10

acute liver failure management

Answer 10

need liver transplant referral immediately

Question 11

acute liver failure is defined as

Answer 11

manifestation of hepatic encephalopathy within 26 weeks of developing symptoms of liver dx

Question 12

liver injury vs acute liver failure

Answer 12

liver injury = see elevated liver tests or jaundice in abscess of liver function failure

Question 13

most common causes of acute liver failure?

Answer 13

medications
viral infections
indeterminant causes

Question 14

management of acute liver failure?

Answer 14

watch for hypoglycemia, hypophosphatemia, acute kidney injury
infections
progressive hepatic encephalopathy - seen with cerebral edema and intracranial hypertension

liver transplant

Question 15

Drug induced liver injury

Answer 15

or injury see heptocellular cholestatic jaundice and normal albumin

can happen after any drug with mean onset of 15 days
2-55 days after

see it commonly with amoxicillin-clavulanic acid

Question 16

jaundice, pruritis, dark urine can have rash and no signs of chronic cirrhosis

history of taking a antibiotic 2 weeks ago (augmentin)

Answer 16

drug induced liver injury

Question 17

drug induced liver injury tx

Answer 17

supportive

stop drug

won’t have encephalopathy or coagulopathy

Question 18

Common drugs that can cause liver injury are:

Answer 18

statins
tylenol
amiodarone
isoniazid
valproic acid
methotrexate