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Increasing role of acetaminophen in acute liver failure in the United States

"Acetaminophen poisoning has become the most common cause of acute liver failure in the United States," report the authors of a new study in the December 2005 issue of Hepatology, the official journal of the American Association for the Study of Liver Diseases (AASLD). While attempted suicides still account for many cases, almost half are the result of unintentional overdose.

Acetaminophen is the most widely used pain reliever in the United States--36 percent of Americans ingest it at least once a month--but taking more than the recommended dose can lead to fatal liver injury. While intentional overdoses generally present early after ingestion and can be treated with N-acetylcysteine, unintentional overdoses are usually not recognized until later. As a result, lead author Anne M. Larson, M.D. of the University of Washington and her colleagues suspected that patients with acute liver failure from unintentional acetaminophen overdoses would have more severe disease and worse outcomes than patients with intentional overdoses.

To examine this hypothesis the researchers conducted a prospective study of patients presenting with acute liver disease to any of 22 academic centers participating in the Acute Liver Failure Study Group. Of 662 consecutive patients over a six-year period between 1998 and 2003, 275 had acetaminophen-related acute liver failure. For each of these patients, the researchers gathered demographic and clinical information, including illness severity, history of acetaminophen ingestion, and outcome.

Acute liver failure cases attributed to acetaminophen increased from 28 percent in 1998 to 51 percent in 2003. These patients were predominantly female (74 percent) and Caucasian (88 percent.) While 44 percent had intentionally overdosed on the drug in suicide attempts, 48 percent had overdosed unintentionally, either by taking combinations of products containing acetaminophen, or taking more than the recommended dosage of a single pr
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Contact: David Greenberg
dgreenbe@wiley.com
201-748-6484
John Wiley & Sons, Inc.
29-Nov-2005


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