Association of acetaminophen hepatotoxicity with fasting and ethanol use

• Published in: JAMA : the journal of the American Medical Association Vol. 272; no. 23; p. 1845
• Main Authors: Whitcomb, D.C. (Prebysterian University Hospital, Pittsburgh, PA.), Block, G.D
• Format: Journal Article
• Language: English
• Published: United States 21.12.1994
• Subjects: Acetaminophen - adverse effects; Acetaminophen - metabolism; Acetaminophen - poisoning; Adolescent; Adult; Aged; Alcohol Drinking - adverse effects; Alcoholism - complications; BEBIDAS ALCOHOLICAS; BOISSON ALCOOLISEE; Chemical and Drug Induced Liver Injury; Drug Overdose - complications; Drug Synergism; Ethanol - adverse effects; Ethanol - metabolism; EXPERIMENTACION; EXPERIMENTATION; Fasting - adverse effects; Fasting - metabolism; Female; FEMME; FOIE; HIGADO; HOMBRES; HOMME; Humans; Liver - drug effects; Liver - metabolism; Male; MEDICAMENT; MEDICAMENTOS; Middle Aged; MUJERES; PENNSYLVANIA; PENNSYLVANIE; Retrospective Studies; TOXICIDAD; TOXICITE
• ISSN: 0098-7484; 1538-3598
• DOI: 10.1001/jama.1994.03520230055038

Objectives--To evaluate the association of fasting and alcohol use with hepatotoxicity from acetaminophen ingested for therapeutic reasons. Design--Retrospective case series. Setting--Hospitals of the University of Pittsburgh(Pa) Medical Center. Patients--A total of 126779 discharge summaries from January 1987 to July 1993 were reviewed using a comprehensive, whole-text-indexed medical database to identify all patients with acetaminophen ingestion and hepatotoxicity. These patients were categorized according to the intended acetaminophen use and dose of acetaminophen ingested. Main Outcomes Measured--The independent variables of chronic alcohol use, recent alcohol use, and recent fasting were determined for all patients. Results--Forty-nine patients with acetaminophen hepatotoxicity (aspartate aminotransferase 1000 U/L) were identified. Twenty-one patients (43%) ingested acetaminophen for therapeutic purposes. All patients with hepatotoxicity took more than the recommended limit of 4 g/d. Recent fasting was more common than recent alcohol use among those who suffered hepatotoxicity after a dose of 4 to 10 g of acetaminophen per day (P=.02). Recent alcohol use was more common in the group who took more than 10 g/d than in those who took 4 to 10 g/d (P=.004). Conclusion--Acetaminophen hepatotoxicity after a dose of 4 to 10 g/d was associated with fasting and less commonly with alcohol use. Patients who developed hepatoxicity after taking acetaminophen doses of greater than 10 g/d for therapeutic purposes were alcohol users. Acetaminophen hepatotoxicity after an overdose appears to be enhanced by fasting in addition to alcohol ingestion