A Case of Acute Liver Failure After Intravenous Administration of Recommended Therapeutic Dose Acetaminophen for Relief of Stage IV Lung Cancer Pain
- VernacularTitle:肺がんStage IVのがん性疼痛緩和に用いた推奨治療用量のアセトアミノフェン注射剤による急性肝不全の1例
- Author:
Kayo TAKIMOTO
1
Author Information
- Keywords: intravenous acetaminophen; acute hepatic failure; drug-induced liver injury; hemoadsorption; N-acetylcystein
- From:Palliative Care Research 2022;17(2):71-75
- CountryJapan
- Language:Japanese
- Abstract: Introduction: There are many reports about hepatotoxicity associated with acute overdose or long-term use of acetaminophen, but few reports of that associated with therapeutic doses. We present a case of acute liver failure with hepatic coma caused by therapeutic doses of intravenous acetaminophen for cancer pain relief in palliative care setting. Case: The patient was a 56-year-old woman with stage IV lung cancer and normal liver function. She was admitted to the hospital because of anorexia and cancer pain. She received 1g intravenous acetaminophen every six hours for analgesia of pleural and rib metastasis. The patient’s AST/ALT levels were elevated at 3104/1212 IU/L, while she was receiving 11 doses of intravenous acetaminophen. She was treated with oral N-acetylcysteine, hemadsorption and plasma exchange therapy. Liver function returned to normal soon. Discussion: Therapeutic doses of intravenous acetaminophen is generally used in palliative care setting, and hepatic failure may occur due to glutathione depletion in patients with cancer anorexia. The potential hazard of rare but serious complications should always be kept in mind even with therapeutic doses.
