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[Fatal acute liver damage caused by a therapeutic dose of paracetamol]

I Kádas1, F Könczöl, T Illés

  • 1Pécsi Orvostudományi Egyetem, Igazságügyi Orvostani Intézet.

Orvosi Hetilap
|March 14, 1998
PubMed

Insights

Paracetamol can cause severe liver injury, even at therapeutic doses, especially in malnourished patients. This case highlights the risk of fatal hepatotoxicity in individuals with depleted glutathione levels.

Area of Science:

  • Hepatology
  • Toxicology
  • Pediatric Surgery

Background:

  • Severe scoliosis necessitates surgical intervention, often involving postoperative fever management.
  • Paracetamol (acetaminophen) is a common antipyretic used to manage postoperative fever.
  • Hepatic glutathione depletion is a known risk factor for drug-induced liver injury.

Observation:

  • A 16-year-old boy received 3500 mg of paracetamol over 3 days post-scoliosis surgery.
  • The patient developed confusion, jaundice, and progressing to unconsciousness.
  • Fulminant hepatic failure was diagnosed, leading to death within 24 hours.

Findings:

  • Autopsy revealed centrilobular liver cell necrosis consistent with paracetamol hepatotoxicity.
  • The patient was malnourished and fasting during the postoperative period.
  • These factors likely depleted hepatic glutathione, increasing susceptibility to paracetamol toxicity.

Implications:

  • Paracetamol can induce severe liver injury even at recommended doses in susceptible individuals.
  • Malnutrition and fasting are critical risk factors for paracetamol-induced hepatotoxicity.
  • Clinicians must consider nutritional status when prescribing paracetamol, especially in postoperative pediatric patients.

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