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ACETAMINOPHEN HEPATOTOXICITY LINKED TO FASTING AND ALCOHOL USE.

Acetaminophen in doses above 15 grams can cause liver toxicity, but some patients develop this complication at lower dosages. To identify risk factors for liver damage, researchers identified 49 patients with severe acetaminophen hepatotoxicity among over 125,000 patients admitted to a Pittsburgh teaching hospital from 1987 to 1993.

All 49 patients had aspartate aminotransferase levels above 1000 U/l. Twenty-eight had taken an intentional overdose, while 21 had used excessive acetaminophen doses to treat various ailments, including flu-like syndromes, toothache, and abdominal pain. Ten of these 21 patients had used only moderately excessive doses (4 to 10 g in 24 hours); of these, eight were noted to have been fasting before developing symptoms, and the remaining two had illnesses that may have diminished caloric intake. Toxicity from higher excessive doses (more than 10 g in 24 hours) was associated with both fasting and recent alcohol use.

Comment: This study shows that moderate overdoses of acetaminophen can cause hepatotoxicity after fasting. Like any drug, acetaminophen should be used in appropriate dosages. However, the data also indicate that it remains among the safest of analgesic agents: it is reassuring that toxicity was so rare despite acetaminophen being used so commonly.

— TH Lee

Published in Journal Watch General Medicine December 27, 1994

Citation(s):

Whitcomb DC; Block GD. Association of acetaminophen hepatotoxicity with fasting and ethanol use. JAMA 1994 Dec 21 272 1845-1850.

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