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Path: Liver 5 - Liver, Pancreas, Biliary tract (iii) (ALF (Features (high…
Path: Liver 5 - Liver, Pancreas, Biliary tract (iii)
Paracetamol toxicity
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lower doses toxic if glutathione depletion (e.g. fasting, malnutrition), enzyme indiction (e.g. alcohol, anticonvulsants)
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metabolism in overdose
conjugation overwhelmed, more NAPQI
glutathione stores become depleted - toxic from NAPQI accumulates - acute liver necrosis in zone 3 with risk of ALF
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ALF
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excl pre-existing chronic disease (severe acute hep or severe acute flares of chronic liver disease may show similarities)
causes
drugs
paracetamol (dose-related, intentional or not)
idiosyncratic drug reactions (anticonvulsants, isoniazid, rarely antibiotics + NSAIDs)
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Features
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cerebral oedema (seizures, stroke)
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OLT
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organ supply
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auxiliary transplants? (implantation of donor's partial/whole liver graft in a heterotopic or orthotopic position with retention of all or part of the native liver)
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