Association of acetaminophen hepatotoxicity with fasting and ethanol use.
Association of acetaminophen hepatotoxicity with fasting and ethanol use.
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DOI：
10.1001/jama.1994.03520230055038
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发表时间：
1994-12
期刊：
影响因子：
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通讯作者：
D. Whitcomb;G. D. Block
中科院分区：
文献类型：
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作者：
D. Whitcomb;G. D. Block
目的：评价禁食和饮酒与因治疗原因摄入对乙酰氨基酚引起的肝毒性之间的关系。设计回顾性病例系列。匹兹堡大学医学中心医院。使用一个全面的、全文索引的医学数据库，对1987年1月至1993年7月的126，779例出院总结进行了回顾，以确定所有摄入对乙酰氨基酚和肝毒性的患者。根据对乙酰氨基酚的预期用途和摄入的对乙酰氨基酚剂量对这些患者进行分类。主要结果测量所有患者的慢性饮酒、近期饮酒和近期禁食的独立变量。结果确定了49例对乙酰氨基酚肝毒性患者（天冬氨酸转氨酶> 1000 U/L）。21例患者（43%）摄入对乙酰氨基酚用于治疗目的。所有肝毒性患者均超过推荐限值4 g/d。在每天服用4 - 10 g对乙酰氨基酚后出现肝毒性的患者中，近期禁食比近期饮酒更常见（P = .02）。近期饮酒在服用超过10 g/d的人群中比服用4 - 10 g/d的人群更常见（P = .004）。结论：对乙酰氨基酚4 ~ 10 g/d剂量后的肝毒性与禁食有关，与饮酒有关的较少。出于治疗目的，服用对乙酰氨基酚剂量大于10 g/d后发生肝毒性的患者为酒精使用者。过量服用对乙酰氨基酚后的肝毒性似乎会因禁食和饮酒而增强。
OBJECTIVES To evaluate the association of fasting and alcohol use with hepatotoxicity from acetaminophen ingested for therapeutic reasons. DESIGN Retrospective case series. SETTING Hospitals of the University of Pittsburgh (Pa) Medical Center. PATIENTS A total of 126,779 discharge summaries from January 1987 to July 1993 were reviewed using a comprehensive, whole-text-indexed medical database to identify all patients with acetaminophen ingestion and hepatotoxicity. These patients were categorized according to the intended acetaminophen use and dose of acetaminophen ingested. MAIN OUTCOMES MEASURED The independent variables of chronic alcohol use, recent alcohol use, and recent fasting were determined for all patients. RESULTS Forty-nine patients with acetaminophen hepatotoxicity (aspartate aminotransferase > 1000 U/L) were identified. Twenty-one patients (43%) ingested acetaminophen for therapeutic purposes. All patients with hepatotoxicity took more than the recommended limit of 4 g/d. Recent fasting was more common than recent alcohol use among those who suffered hepatotoxicity after a dose of 4 to 10 g of acetaminophen per day (P = .02). Recent alcohol use was more common in the group who took more than 10 g/d than in those who took 4 to 10 g/d (P = .004). CONCLUSION Acetaminophen hepatotoxicity after a dose of 4 to 10 g/d was associated with fasting and less commonly with alcohol use. Patients who developed hepatoxicity after taking acetaminophen doses of greater than 10 g/d for therapeutic purposes were alcohol users. Acetaminophen hepatotoxicity after an overdose appears to be enhanced by fasting in addition to alcohol ingestion.