A 7-YEAR EXPERIENCE OF SEVERE ACETAMINOPHEN-INDUCED HEPATOTOXICITY (1987-1993)

Background & Aims: Five hundred sixty patients admitted between Januar y 1, 1987, and December 31, 1993, with severe acetaminophen-induced he patotoxicity were studied. The aim of this study was to identify why s evere acetaminophen-induced hepatotoxicity stilt occurs and to determi ne how known risk factors and advances in management have affected the pattern of illness and outcome. Methods: This was a retrospective stu dy of the etiologic factors and the clinical course of all acetaminoph en-related admissions. Results: The number of admissions increased fro m 58 in 1987 to 123 in 1993. During the corresponding period, overall survival improved from just <50% to 78%. The percentage of admissions treated with N-acetylcysteine increased from 40% in 1987 to 83% in 199 3. The frequency with which grade Ill or IV encephalopathy developed d ecreased from 62% in 1987 to 40% in 1993, and the percentage of these patients who developed cerebral edema decreased from 61% to 45% during the same period. There was an increase in both the number of patients transplanted and the survival of those managed medically. Conclusions : Severe acetaminophen-induced hepatotoxicity remains a serious condit ion, but the increasing use of N-acetylcysteine, advances in medical m anagement, and the increasing availability of transplantation have res ulted in a significant improvement in survival rates.