Late extensive intravenous administration of N-acetylcysteine can reverse hepatic failure in acetaminophen overdose

2010 ◽  
Vol 30 (1) ◽  
pp. 51-54 ◽  
Author(s):  
Omid Mehrpour ◽  
Shahin Shadnia ◽  
Hossein Sanaei-Zadeh
Keyword(s):  
Liver Failure ◽  
Intravenous Administration ◽  
Attempted Suicide ◽  
Substantial Improvement ◽  
High Dose ◽  
Poison Center ◽  
Drug Induced ◽  
Impaired Liver ◽  
Level Of Consciousness ◽  
Liver Functions

Acetaminophen is a commonly used analgesic and has been shown to be a main cause of drug-induced liver failure. N-acetylcysteine (NAC) should be employed as the antidote in case of acetaminophen poisoning within the first 8-10 hours. Oral administration of NAC is universally recommended and due to the adverse effects, the intravenous administration of the agent is reserved for patients with oral intolerance and severe complications. We here report an 18-year-old man with severe liver failure due to a huge ingestion of acetaminophen, who was taken into the Loghman Hakim Hospital Poison Center 72 hours after attempted suicide. Regarding the poor prognostic clues as his level of consciousness and impaired liver functions, an extensive intravenous regimen of NAC was started. The patient survived the condition with an additional intravenous administration of NAC past the first 72 hours of treatment. We discuss that even in late phases of intoxication; high-dose intravenous NAC can serve a substantial improvement.

High-dose methotrexate-induced reversible grade 4 hyperbilirubinaemia and transaminitis in an adolescent with Burkitt Leukaemia

2021 ◽  
Vol 14 (1) ◽  
pp. e237512
Author(s):  
Sanjeev Khera ◽  
Randhir Ranjan ◽  
Sateesh Ramachandran ◽  
Ajay Beriwal
Keyword(s):  
Liver Injury ◽  
Clinical Significance ◽  
Short Latency ◽  
High Dose ◽  
High Dose Methotrexate ◽  
Drug Induced ◽  
Common Cause ◽  
Drug Induced Liver Injury ◽  
Dose Methotrexate

Symptomatic drug-induced liver injury (DILI) is an uncommon problem. Direct DILI is dose-related, predictable with short latency (hour to days) and is generally associated with transient and reversible transaminitis without jaundice. Antimetabolites including methotrexate are a common cause for direct DILI. Hepatotoxicity associated with high-dose methotrexate (HD-MTX) is generally transient and includes reversible elevation of transaminase in up to 60% and associated hyperbilirubinaemia (≤grade 2) in 25% of courses and therefore is of no clinical significance. Severe grades of DILI with HD-MTX (grade ≥4) are extremely rare. We describe an adolescent with Burkitt leukaemia who had reversible grade 4 DILI including hyperbilirubinaemia postfirst course of HD-MTX. Rechallenge with two-third dose of HD-MTX in subsequent chemotherapeutic cycle did not cause recurrence of DILI.

scholarly journals A possible interaction between favipiravir and methotrexate: Drug-induced hepatotoxicity in a patient with osteosarcoma

2021 ◽  
pp. 107815522110313
Author(s):  
Emre Demir ◽  
Osman Sütcüoğlu ◽  
Beril Demir ◽  
Oktay Ünsal ◽  
Ozan Yazıcı
Keyword(s):  
Drug Interactions ◽  
Toxic Hepatitis ◽  
Antiviral Agents ◽  
Antiviral Agent ◽  
Aldehyde Oxidase ◽  
Chemotherapeutic Agents ◽  
High Dose ◽  
Drug Induced ◽  
Metastatic Osteosarcoma ◽  
Grade 3

Introduction Favipiravir is an antiviral agent that is recently used for SARS-CoV2 infection. The drug-drug interactions of favipiravir especially with chemotherapeutic agents in a patient with malignancy are not well known. Case report The patient diagnosed with metastatic osteosarcoma was given high dose methotrexate treatment, and favipiravir was started on the third day of the treatment with suspicion of SARS-CoV2 infection. Grade 3 hepatotoxicity developed after favipiravir. Management & outcome: The acute viral hepatitis panel and autoimmune liver disease panel were negative. The ultrasound of the abdomen was unremarkable for any hepatobiliary pathology. The all viral and hepatobiliary possible etiological factors were ruled out. The patient’s liver enzymes increased just after (12 hours later) the initiation of favipiravir, and we diagnosed toxic hepatitis caused by favipiravir-methotrexate interaction. Therefore, methylprednisolone 1 mg/kg dose was started for a presumed diagnosis of toxic hepatitis. Hepatotoxicity completely regressed after favipiravir was discontinued. Discussion Favipiravir may inhibit methotrexate elimination by inhibiting aldehyde oxidase and its sequential use may cause hepatotoxicity in this case. The clinicians should keep in mind possible drug interactions while using new antiviral agents against SARS-CoV2 like favipiravir.

Myoclonus Due to Chlorambucil in Two Adults with Lymphoma

1997 ◽  
Vol 31 (2) ◽  
pp. 171-174 ◽  
Author(s):  
Andrew Rj Wyllie ◽  
Charles D Bayliff ◽  
Michael J Kovacs
Keyword(s):  
Nephrotic Syndrome ◽  
Science Citation Index ◽  
Low Dose ◽  
Citation Index ◽  
Science Citation ◽  
Data Sources ◽  
High Dose ◽  
Drug Induced ◽  
Neurologic Status ◽  
Subsequent Decrease

Objective To report myoclonus due to chlorambucil therapy in two adults with lymphoma, and to review the literature of chlorambucil neurotoxicity in adults. Case Summaries Case 1: An 81-year-old man with lymphoma being treated with chlorambucil developed jerking movements and stiffness that persisted for 3 days and intensified at night. The dosage of chlorambucil was decreased with a subsequent decrease in symptomatology. Resolution of the myoclonus occurred with discontinuation of the chlorambucil. Rechallenge evoked a return of tremors the next day that later became constant and again resolved on discontinuation of chlorambucil. Case 2: A 75-year-old woman with lymphoma being treated with chlorambucil developed jerking movements in her limbs, particularly in her arms and right hip. The symptoms were so severe they prevented the patient from leaving her house. All symptoms resolved within 2–3 days after the cycle was completed and did not return. She was diagnosed as having had chlorambucil-induced myoclonus. Data Sources Searches were performed on MEDLINE, CancerLit, and Science Citation Index Review to identify reports and articles discussing chlorambucil-induced neurotoxicity, particularly myoclonus. Discussion Chlorambucil-induced myoclonus has been described in overdose situations and in the treatment of nephrotic syndrome in children. Three cases of reversible myoclonic activity associated with high-dose chlorambucil in adults have also been described. In each case, the myoclonus resolved following discontinuation of the drug. Only one other conclusive case of low-dose chlorambucil-induced myoclonus in an adult has been described. The two cases presented here are unique in that the myoclonus occurred in adults receiving low-dose chlorambucil who had no myoclonus before or after treatment with the drug. Conclusions From the cases reviewed, it appears that chlorambucil may induce myoclonus in adults receiving therapeutic dosages of chlorambucil. The neurologic status of patients receiving chlorambucil should be followed closely during treatment. If myoclonus develops, drug-induced myoclonus should be considered, as well as discontinuation of the drug.

scholarly journals Safety and Efficacy of Intermittent Intravenous Administration of High-Dose Micafungin

2015 ◽  
Vol 61 (suppl_6) ◽  
pp. S652-S661 ◽  
Author(s):  
Dionysis Neofytos ◽  
Yao-Ting Huang ◽  
Kimberly Cheng ◽  
Nina Cohen ◽  
Miguel-Angel Perales ◽  
...  
Keyword(s):  
Intravenous Administration ◽  
High Dose ◽  
Safety And Efficacy

Drug-induced optic neuropathy in a case of extensively drug-resistant pulmonary tuberculosis

2018 ◽  
Vol 30 (1) ◽  
pp. 139-140 ◽  
Author(s):  
Proteesh Rana ◽  
Vandana Roy ◽  
Jamshed Ahmad
Keyword(s):  
Pulmonary Tuberculosis ◽  
Optic Neuritis ◽  
Male Patient ◽  
Optic Neuropathy ◽  
High Dose ◽  
Drug Resistant ◽  
Drug Reactions ◽  
Drug Induced ◽  
Toxic Optic Neuropathy ◽  
Extensively Drug Resistant

Abstract We report a 26-year-old male patient diagnosed with extensively drug-resistant pulmonary tuberculosis presenting with reversible bilateral toxic optic neuropathy induced by the use of linezolid along with high-dose isoniazid. The case emphasizes the importance of recognizing toxic optic neuritis in patients on antitubercular therapy. Prompt recognition and treatment of such adverse drug reactions will reduce the associated morbidity.

scholarly journals Effects of Oral L-Carnitine on Liver Functions after Transarterial Chemoembolization in Intermediate-Stage HCC Patients

2015 ◽  
Vol 2015 ◽  
pp. 1-10 ◽  
Author(s):  
Abeer Hassan ◽  
Yasuhiro Tsuda ◽  
Akira Asai ◽  
Keisuke Yokohama ◽  
Ken Nakamura ◽  
...  
Keyword(s):  
Serum Albumin ◽  
Transarterial Chemoembolization ◽  
Intermediate Stage ◽  
Control Group ◽  
Control Groups ◽  
Medical College ◽  
Impaired Liver ◽  
Liver Functions ◽  
Branched Chain ◽  
And Control

Transarterial chemoembolization (TACE) is usually followed by hepatic dysfunction. We evaluated the effects of L-carnitine on post-TACE impaired liver functions.Methods. 53 cirrhotic hepatocellular carcinoma patients at Osaka Medical College were enrolled in this study and assigned into either L-carnitine group receiving 600 mg oral L-carnitine daily or control group. Liver functions were evaluated at pre-TACE and 1, 4, and 12 weeks after TACE.Results. The L-carnitine group maintained Child-Pugh (CP) score at 1 week after TACE and exhibited significant improvement at 4 weeks after TACE (P<0.01). Conversely, the control group reported a significant CP score deterioration at 1 week (P<0.05) and 12 weeks after TACE (P<0.05). L-carnitine suppressed serum albumin deterioration at 1 week after TACE. There were significant differences between L-carnitine and control groups regarding mean serum albumin changes from baseline to 1 week (P<0.05) and 4 weeks after TACE (P<0.05). L-carnitine caused prothrombin time improvement from baseline to 1, 4 (P<0.05), and 12 weeks after TACE. Total bilirubin mean changes from baseline to 1 week after TACE exhibited significant differences between L-carnitine and control groups (P<0.05). The hepatoprotective effects of L-carnitine were enhanced by branched chain amino acids combination.Conclusion. L-carnitine maintained and improved liver functions after TACE.

scholarly journals Safety and Efficacy of Intermittent Intravenous Administration of High-Dose Micafungin

2015 ◽  
Vol 2 (suppl_1) ◽  
Author(s):  
Dionysios Neofytos ◽  
Yao-Ting Huang ◽  
Kim Cheng ◽  
Nina Cohen ◽  
Miguel Perales ◽  
...  
Keyword(s):  
Intravenous Administration ◽  
High Dose ◽  
Safety And Efficacy

scholarly journals Necrotizing sarcoid granulomatosis with clinical presentations of recurrent acute abdomen. Case report and literature review

2017 ◽  
Vol 89 (11) ◽  
pp. 60-68 ◽  
Author(s):  
V I Vasilyev ◽  
S G Palshina ◽  
B D Chaltsev ◽  
S G Radenska-Lopovok ◽  
T N Safonova
Keyword(s):  
Acute Abdomen ◽  
Clinical Laboratory ◽  
Morphological Changes ◽  
Abdominal Cavity ◽  
High Dose ◽  
Drug Induced ◽  
Serological Tests ◽  
Surgical Interventions ◽  
First Case ◽  
Clinical Presentations

The authors have described the world’s first case of necrotizing sarcoid granulomatosis (NSG) in a 22-year-old woman with the clinical presentations of acute abdomen, which are associated with abdominal lymph nodal infiltration and necrosis, obvious constitutional disturbances (fever, nocturnal sweats, and significant weight loss), high inflammatory activity (anemia, leukocytosis, high erythrocyte sedimentation rates and C-reactive protein levels), the gradual appearance of splenic and hepatic necrotic foci, and infiltration into the lung and lacrimal glands with the development of unilateral uveitis. The patient underwent five surgical interventions, several needle biopsies for recurrent abdominal syndrome, and long-term antibiotic treatment for presumed sepsis, which had caused drug-induced hepatitis. Bacteriological examination of blood, puncture samples, and removed abdominal cavity tissues, serological tests, and immunomorphogical study of biopsy samples and removed tissues yielded negative results for the presence of bacterial, fungal, and tuberculosis infections. NSG was diagnosed on the basis of the systemic nature of the lesion, the presence of granulomas with severe abdominal lymph nodal necrosis and necrotizing granulomatous/lymphocytic vasculitis in the mesentery and removed spleen, as well as the absence of granulomas in the spleen, appendix, and biopsy materials of the liver, colonic mucosa, and parotid gland. Fludarabine therapy was first used in world practice due to the inefficient treatment with high-dose glucocorticoids and cyclophosphamide and to a disease relapse when reducing their doses. The paper gives a detailed review of the literature on the clinical, laboratory, radiological, and morphological manifestations of the disease, which allow the differential diagnosis of NSG with different variants of granulomatous lesions. Based on the 5-year follow-up of the patient and on the analysis of clinical, laboratory, radiological, and morphological changes, the authors uphold the concept that the disease is an independent nosological entity: necrotizing angiitis with sarcoid reactions, rather than the entity of nodular or classic sarcoidosis.

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