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Updated: Aug 20, 2025

Generation of a Rat Model of Acute Liver Failure by Combining 70% Partial Hepatectomy and Acetaminophen
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Intravenous acetaminophen associated with acute liver failure.

Maunoo Lee1, Joshua McCarron2, Aaron Balinski3

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Summary

Intravenous acetaminophen can cause acute liver failure (ALF), even at recommended doses. This rare case highlights the risk of IV acetaminophen, emphasizing careful monitoring for hepatotoxicity.

Keywords:
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Area of Science:

  • Hepatology
  • Pharmacology
  • Internal Medicine

Background:

  • Acetaminophen (APAP) overdose is a leading cause of acute liver failure (ALF) in many countries.
  • Most documented cases involve oral APAP ingestion, with intravenous (IV) APAP-induced ALF being exceptionally rare.

Observation:

  • A woman in her mid-60s with a partial colonic obstruction received 13g of IV acetaminophen over 6 days (max 4g/24h).
  • She developed encephalopathy and an INR of 6.1, meeting criteria for ALF.
  • Other causes of liver failure were excluded.

Findings:

  • The patient was treated with IV N-acetylcysteine, leading to resolution of encephalopathy and improved liver chemistries.
  • This case represents a rare instance of ALF induced by therapeutic IV acetaminophen administration.

Implications:

  • Clinicians should be aware of the potential for IV acetaminophen to cause ALF, even when administered within recommended daily limits.
  • Careful patient selection and monitoring are crucial, particularly in patients with risk factors for hepatotoxicity.
  • Further research into the specific risks and safe dosing of IV acetaminophen in various clinical settings is warranted.