[Severe toxic acute liver failure: etiology and treatment]

R Amathieu; E Levesque; J-C Merle; M Chemit; C Costentin; P Compagnon; G Dhonneur

doi:10.1016/j.annfar.2013.03.004

[Severe toxic acute liver failure: etiology and treatment]

Ann Fr Anesth Reanim. 2013 Jun;32(6):416-21. doi: 10.1016/j.annfar.2013.03.004. Epub 2013 May 14.

[Article in French]

Authors

R Amathieu¹, E Levesque, J-C Merle, M Chemit, C Costentin, P Compagnon, G Dhonneur

Affiliation

¹ Service d'anesthésie et des réanimations, réanimation chirurgicale hépatobiliaire, digestive et transplantation, université Paris-12, CHU Henri-Mondor, 51, avenue de Lattre-de-Tassigny, 94000 Créteil, France. [email protected]

PMID: 23683460
DOI: 10.1016/j.annfar.2013.03.004

Abstract

Many substances, drugs or not, can be responsible for acute hepatitis. Nevertheless, toxic etiology, except when that is obvious like in acetaminophen overdose, is a diagnosis of elimination. Major causes, in particular viral etiologies, must be ruled out. Acetaminophen, antibiotics, antiepileptics and antituberculous drugs are the first causes of drug-induced liver injury. Severity assessment of the acute hepatitis is critical. Acute liver failure (ALF) is defined by the factor V, respectively more than 50% for the mild ALF and less than 50% for the severe ALF. Neurological examination must be extensive to the search for encephalopathy signs. According to the French classification, fulminant hepatitis is defined by the presence of an encephalopathy in the two first weeks and subfulminant between the second and 12th week after the advent of the jaundice. During acetaminophen overdose, with or without hepatitis or ALF, intravenous N-acetylcysteine must be administered as soon as possible. In the non-acetaminophen related ALF, N-acetylcysteine improves transplantation-free survival. Referral and assessment in a liver transplantation unit should be discussed as soon as possible.

Publication types

Review

MeSH terms

Acetaminophen / adverse effects
Acetylcysteine / administration & dosage
Acetylcysteine / therapeutic use
Acute Kidney Injury / etiology
Acute Kidney Injury / therapy
Anti-Infective Agents / adverse effects
Anti-Infective Agents / therapeutic use
Blood Coagulation Disorders / drug therapy
Blood Coagulation Disorders / etiology
Chemical and Drug Induced Liver Injury / diagnosis
Chemical and Drug Induced Liver Injury / drug therapy
Chemical and Drug Induced Liver Injury / etiology*
Chemical and Drug Induced Liver Injury / surgery
Chemical and Drug Induced Liver Injury / therapy*
Cholestasis / diagnosis
Combined Modality Therapy
Diagnosis, Differential
Disease Management
Hepatic Encephalopathy / diagnosis
Hepatic Encephalopathy / etiology
Hepatic Encephalopathy / surgery
Hepatitis, Viral, Human / diagnosis
Humans
Illicit Drugs / adverse effects
Liver Failure, Acute / chemically induced*
Liver Failure, Acute / drug therapy
Liver Failure, Acute / therapy*
Liver Function Tests
Liver Transplantation
Mushroom Poisoning / diagnosis
Neurologic Examination
Occupational Diseases / chemically induced
Occupational Diseases / therapy
Respiratory Insufficiency / etiology
Respiratory Insufficiency / therapy
Sepsis / drug therapy
Sepsis / etiology
Shock / etiology
Shock / therapy
Time Factors
Valproic Acid / adverse effects

Substances

Anti-Infective Agents
Illicit Drugs
Acetaminophen
Valproic Acid
Acetylcysteine