Reactions 1480, p32 - 30 Nov 2013

SParacetamol

Cerebral oedema and fulminant liver failure: 2 casereports

Two patients developed cerebral oedema and fulminantliver failure secondary to paracetamol [acetaminophen]toxicity [indications, routes, dosages and durations oftreatment to reactions onset not stated].

Patient 1 was a 29-year-old woman with a history ofdepression and patient 2 was a 37-year-old woman with ahistory of alcohol dependence. Both patients presented withencephalopathy and coagulopathy following exposure toparacetamol. They subsequently developed coma andhyperacute progression of liver failure, with serum ammonialevels >100 µmol/L.

Both patients were treated with vasopressors and renalreplacement therapy. Their neurological status worsened, withsigns of impending central herniation, including extensorposturing, sustained clonus and bilateral Babinskis. CT scansconfirmed cerebral oedema. Rescue therapy withhypernatraemia (sodium 145-150 mmol/L) and hypothermia(32°C) was administered for 1 day in patient 1, and for 6 daysin patient 1. Both patients recovered completely, and weredischarged on hospital days 20 and 32, respectively.

Author comment: "We report our 5-year experience onadvanced cerebral edema and impending cerebral herniationin transplant-ineligible patients with fulminant liver failuresecondary to acetaminophen toxicity."Kerdsirichairat T, et al. Rescue therapy with hypernatremia/hypothermia protocolin transplant-ineligible patients with advanced cerebral edema from acetaminophentoxicity: Case series from tertiary care center. American Journal ofGastroenterology 108: S342, Oct 2013. Available from: URL: http://dx.doi.org/10.1038/ajg.2013.267 [abstract] - USA 803096323

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Reactions 30 Nov 2013 No. 14800114-9954/13/1480-0001/$14.95 Adis © 2013 Springer International Publishing AG. All rights reserved