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.
ABSTRACT
Dysregulated response of cytokines can result in hyper-inflammatory conditions called cytokine storm,commonly seen in sepsis and septic shock..The current study assessed hemoadsorption device - CytoSorb® for its efficiency as an adjuvant in treating patients suffering from septic shock. Total 8 patients enrolled were subjected to hemoadsorption therapy along with the standard treatment.The results of the study revealed significant improvement in clinical and haemodynamic parameters before and after initiation of CytoSorb® therapy. Out of 8 patients, 6 showed a positive outcome while 2 did not survive.The results of this study show that the use of hemoadsorption therapy can be considered in critically ill ICU patients as a safe and effective adjuvant therapy along with the standard treatment for a better outcome in patients.