Hepatotoxicity after paracetamol overdose in a patient with cystic fibrosis despite early acetylcysteine and utility of microRNA to predict hepatotoxicity. (3rd October 2018)

• Record Type: Journal Article
• Authors: Wong, Anselm; Cheung, Benjamin; Nejad, Charlotte; Gantier, Michael; Graudins, Andis
• Is Part Of: Clinical toxicology. Volume 56:Number 10(2018)
• Page Start: 904
• Page End: 906
• Publication Date: 2018-10-03
• Subjects: Acetaminophen -- risk assessment -- liver injury -- nomogram; Toxicology -- Periodicals; Toxicological emergencies -- Periodicals; 615.9
• DOI: 10.1080/15563650.2018.1454596
• Languages: English
• ISSNs: 1556-3650

Abstract

Abstract: Case details: A 19-year-old girl presented to the emergency department following overdose of 10 g of paracetamol on a background history of cystic fibrosis. Paracetamol concentration was below the nomogram line, but was treated with acetylcysteine seven hours post-overdose given her symptomatology. Nineteen hours following her overdose she developed hepatotoxicity, despite early initiation of acetylcysteine. She was discharged well six days post-ingestion. On presentation, delta miRNA-122-miR483 was 20 times that of control patients, however, alanine aminotransferase was normal. Discussion: Patients with cystic fibrosis are more likely to have glutathione deficiency, and greater susceptibility to liver injury. Delta miRNA may be a better detector of early liver injury than hepatic aminotransferases. Empiric treatment with acetylcysteine and serial biochemical reassessment in this setting should be considered.