Acute Liver Failure in a 64-Year-Old Man

Gregory Taylor, DO; Adam M. Vieder, DO

Disclosures

March 29, 2019

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Background

A 64-year-old man with a significant medical history of chronic obstructive pulmonary disease, alcohol abuse, and depression presented to the intensive care unit as a transfer from an outside hospital for acute hepatic failure. The patient had ingested a large quantity of tablets in an attempted suicide 6 hours before arrival at the previous hospital.

His initial pertinent laboratory evaluation from the outside hospital was notable for the following: 

  • Ethanol level: 320 mg/dL

  • Acetaminophen level: 430 µg/mL

  • Aspartate aminotransferase (AST) level: 2066 U/L

  • Alanine aminotransferase (ALT) level: 1321 U/L

  • Nonhemolyzed potassium level: 7.6 mEq/L

  • Creatinine phosphokinase (CPK) level: 62,530 IU/L

He was placed on a norepinephrine infusion and was intubated secondary to being obtunded. He underwent treatment for hyperkalemia, was started on intravenous N-acetylcysteine (NAC), and was transferred.

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