Article Document Academic Article Information Content Entity Continuant Continuant Journal Article Entity Entity Generically Dependent Continuant 2025-05-06T14:32:16 RDF description of The hepatoprotective effects of N-acetylcysteine with repeated toxic acetaminophen ingestions: a case report - http://repository.healthpartners.com/individual/document-rn20976 16808 2022-02-21T22:48:57.408-06:00 1 The hepatoprotective effects of N-acetylcysteine with repeated toxic acetaminophen ingestions: a case report public 28136 Emergency Medicine 2 document-rn20976 Substance Abuse Poisoning 10.1080/24734306.2018.1498159 Liver Drugs and Drug Therapy <p>Background: It has classically been taught that a patient with acetaminophen toxicity will not have any continued liver dysfunction after recovery from an initial acute insult. Despite this notion, there has not been a<br>case reported in the literature of recurrent acute acetaminophen (APAP)<br>overdose with known time of ingestion.<br>Methods: Retrospective chart review of one patient who presented 27<br>times after large acute acetaminophen ingestion, receiving Nacetylcysteine (NAC) 20 times, without residual signs of liver<br>dysfunction.<br>Methods: The patient’s electronic medical record (EPIC®) was reviewed<br>at patient’s preferred hospital site as well as the Minnesota Poison Control<br>System (Toxicall®) to identify total number of ingestions, serum APAP<br>level, administration of NAC, and subsequent laboratory results. Serial<br>liver function tests and acetaminophen levels were analyzed to attempt to<br>determine induction of metabolism. Results: All presentations were very similar: witnessed by employees at<br>her group home, presented about 1 h after ingestion, and ingested 25 g of<br>APAP (50 tablets of 500 mg; not extended-release). The patient received<br>NAC 20 times over a 9-year period due to a toxic 4-h serum APAP level;<br>13 times in a 6-month period.<br>Despite the repeated toxic acetaminophen insults, there were no residual<br>signs of liver dysfunction. Her aspartate aminotransferase (AST) and<br>alanine aminotransferase (ALT) never reached 40 IU/L. One time, her<br>INR increased to 2.3 the day after a 4-h serum APAP level of 355 mcg/<br>mL, the highest APAP level recorded for this patient. Otherwise, INR was<br>never greater than 1.2.<br>Discussion: This patient was repeatedly witnessed ingesting a potentially hepatotoxic dose of acetaminophen with numerous serum<br>levels above the standard Rumack-Matthew nomogram line. This<br>case illustrates the long-taught concept that there is no residual<br>liver damage if an APAP overdose is adequately treated with Nacetylcysteine and patient reaches stage IV of APAP toxicity. It<br>also provides tangible evidence that repeat toxic ingestions do not<br>have a cumulative effect.<br>Conclusion: This case report demonstrates the intrinsic and repeated<br>hepatic reparative properties as long as the liver is allowed to heal between insults.<p> Toxicology communications