ACETAMINOPHEN MAY BE A LEADING CAUSE OF ACUTE LIVER FAILURE.

In the United States, 42% of acute liver failure (ALF) is caused by acetaminophen, according to the results of a multicenter, prospective cohort study reported in the December issue of Hepatology. Accidental overdose is the leading cause, but suicidal ingestion is also important. “Acetaminophen, the most widely used analgesic in the US, causes severe hepatic necrosis leading to ALF after suicidal overdoses,” write Anne M. Larson, MD, and the Acute Liver Failure Study Group from the University of Washington Medical Center in Seattle, and colleagues. “Unintentional liver injury from self-medication for pain or fever that leads to daily doses exceeding the 4 g/day package recommendations is also well-recognized. Fasting and alcohol use may enhance toxicity, but this remains controversial.” During the study, the annual percentage of acetaminophen-related ALF rose from 28% in 1998 to 51% in 2003. The median dose ingested was 24 g, equivalent to 48 extra-strength tablets. Of the 275 cases, 131 (48%) were unintentional overdoses, 122 (44%) were suicide attempts, and 22 (8%) were of unknown intent. (Larson, A.M., Polson, J., et al., “Acetaminophen-induced acute liver failure: Results of a United States multicenter, prospective study.” Hepatology. 2005;42(6):1364-1372.)