10th Congress of the Andalusian Society of Organ and Tissue Transplantation
Case report
Molecular Adsorbent Recirculating System Treatment Can Reduce Blood Levels of N-Acetylcysteine in Patients With Acetaminophen Overdose: Case Reports

https://doi.org/10.1016/j.transproceed.2017.09.053Get rights and content

Abstract

Background

Acetaminophen poisoning continues to be a major cause of liver failure that can lead to liver transplantation. N-acetylcysteine (NAC) is the cornerstone of treatment. Some authors use a Molecular Adsorbent Recirculating System (MARS) system in acetaminophen poisoning. It is reported that the MARS system eliminates acetaminophen more efficiently than conventional dialysis. It is theoretically possible that treatment with MARS administered after NAC will increase the effectiveness of treatment.

Case Reports

The first patient, a woman of 14 years old, presented blood levels of 112 mg/dL 12 hours after ingestion of 15 g of acetaminophen. Treatment with NAC was initiated. At 17 and 23 hours after ingestion, blood levels were 23.5 μg/mL and 5.9 μg/mL, respectively. The second patient, a woman of 28 years old, presented blood levels of 115 mg/dL 4 hours after ingestion of 40 g of acetaminophen. Treatment with NAC was initiated. At 14 and 23 hours after ingestion, blood levels were 15.8 μg/mL and <2 μg/mL, respectively. In both patients, we performed MARS after completing treatment with NAC, and after the first session, blood levels were below the lower limit of detection (≤2 μg/mL).

Discussion

The correct timing of MARS to avoid interactions with the administered dose of NAC in acetaminophen overdose is essential so as to not impair the effectiveness of this treatment. These considerations in the management of this entity help in the resolution of liver failure, thus avoiding the need for a liver transplant.

Section snippets

Case Reports

The first patient was a 14-year-old girl who came to the emergency room after acetaminophen poisoning as an autolytic attempt. Plasma paracetamol levels measured at 12 hours after ingestion were showed 102 μg/mL, and treatment with intravenous NAC plus activated charcoal by nasogastric tube was started. In the blood test aspartate aminotransferase (AST), alanine aminotransferase (ALT), and prothrombin index levels were 17 IU/L, 18 IU/L, and 79%, respectively. At 17 and 23 hours after ingestion,

Discussion

Acetaminophen is among the most common causes of medication-related poisoning. Serious toxicity results in hepatic injury, which may progress to fulminant hepatic failure. Acetaminophen overdose is the leading cause for calls to poison control centers (>100,000/y) and accounts for an estimated 458 deaths due to acute liver failure each year [5].

The initial management is determinate by the patient's presenting symptoms, but the most used tool to quantified the risk of severe liver damage is the

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