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Multiple Aminotransferase Peak Levels After Acute Acetaminophen Overdose in Three Patients
Author(s) -
Rhyee Sean H.,
Hoppe Jason,
Heard Ken
Publication year - 2010
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1592/phco.30.10.1084
Subject(s) - acetaminophen , medicine , coagulopathy , acetylcysteine , acetaminophen overdose , encephalopathy , alanine aminotransferase , hepatic encephalopathy , anesthesia , gastroenterology , cirrhosis , chemistry , biochemistry , antioxidant
After acetaminophen overdose, typical trends of aspartate and alanine aminotransferase (AST and ALT, respectively) levels consist of a single peak followed by a decrease to baseline. Based on this pattern, declining AST or ALT levels have been proposed as a criterion for when to discontinue N ‐acetylcysteine therapy in patients with acetaminophen overdose. We describe three patients who experienced multiple aminotransferase peak levels after acetaminophen overdose. In each case, an initial peak was followed by a 20% or greater decrease in AST or ALT level, then a second, higher peak exceeding 1000 U/L. In two cases, the second peak correlated with encephalopathy or coagulopathy. Two patients were treated with a continuous infusion of intravenous N ‐acetylcysteine, with treatment interrupted for 4 hours in one of them. As observed in the three patients, multiple aminotransferase peak levels can occur after acetaminophen overdose. Although declining levels typically coincide with clinical improvement, the presence of other markers of liver injury, such as coagulopathy or encephalopathy, should prompt continued N ‐acetylcysteine treatment.