Late presentation of acetaminophen hepatotoxicity

Area of Science:

• Toxicology
• Hepatology
• Internal Medicine

Background:

• Acetaminophen overdose is a common cause of acute liver injury.
• Alcohol use disorder can complicate the diagnosis and management of acetaminophen toxicity.

Observation:

• A 37-year-old male with a history of alcoholism presented with metabolic acidosis, hypoglycemia, hypoprothrombinemia, and elevated SGOT.
• Despite lack of explicit history of acetaminophen ingestion, it was suspected as the cause.

Findings:

• The clinical presentation was highly suggestive of acetaminophen hepatotoxicity.
• The combination of metabolic acidosis, hypoglycemia, and coagulopathy indicated selective hepatocellular dysfunction.

Implications:

• This case highlights the importance of considering acetaminophen hepatotoxicity even in patients with confounding factors like alcoholism.
• Early recognition of these specific biochemical abnormalities can guide timely treatment and improve outcomes in drug-induced liver injury.