Cargando…

A Case of Cocaine-Induced Acute Liver Failure Reversed With N-Acetylcysteine

Acute liver failure (ALF) is a life-threatening injury that is most often caused by drug-induced injury, including acetaminophen overdose, in the United States. The hallmarks of ALF are hepatic encephalopathy and coagulopathy in a patient without an established history of liver disease. While acetam...

Descripción completa

Detalles Bibliográficos
Autores principales: Mitchell, Mary C, Rogers, Cleon
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10407963/
https://www.ncbi.nlm.nih.gov/pubmed/37559860
http://dx.doi.org/10.7759/cureus.41579
_version_ 1785086080400228352
author Mitchell, Mary C
Rogers, Cleon
author_facet Mitchell, Mary C
Rogers, Cleon
author_sort Mitchell, Mary C
collection PubMed
description Acute liver failure (ALF) is a life-threatening injury that is most often caused by drug-induced injury, including acetaminophen overdose, in the United States. The hallmarks of ALF are hepatic encephalopathy and coagulopathy in a patient without an established history of liver disease. While acetaminophen overdose has an antidote, that is N-acetylcysteine (NAC), when given acutely, most other causes of hepatic failure require an urgent liver transplant. In this paper, we report a case of cocaine-induced acute liver failure that was reversed with the administration of NAC. Our case began when a middle-aged male presented to the emergency department complaining of nausea, vomiting, fatigue, and confusion for the past three days. His past medical history was pertinent for a history of opioid use disorder and his physical exam was remarkable for somnolence, asterixis, and periumbilical ecchymoses. His initial lab results showed markedly elevated liver function tests, prolonged coagulation studies, and a urine drug screen that was positive for cocaine. During the patient’s interview, his vital signs became unstable. He was intubated for airway protection and transferred to a tertiary care facility for liver transplant evaluation with the diagnosis of cocaine-induced acute liver failure. There he received NAC, lactulose, rifaximin, and vasopressors. On day two of treatment, his clinical condition greatly improved, and he was extubated. He continued to receive NAC until day five when his liver function tests and coagulopathy improved enough to stop treatment. This case report highlights the clinical benefit of NAC in a case of cocaine-induced acute liver failure, improving the patient’s survival and eliminating his need for a liver transplant.
format Online
Article
Text
id pubmed-10407963
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher Cureus
record_format MEDLINE/PubMed
spelling pubmed-104079632023-08-09 A Case of Cocaine-Induced Acute Liver Failure Reversed With N-Acetylcysteine Mitchell, Mary C Rogers, Cleon Cureus Internal Medicine Acute liver failure (ALF) is a life-threatening injury that is most often caused by drug-induced injury, including acetaminophen overdose, in the United States. The hallmarks of ALF are hepatic encephalopathy and coagulopathy in a patient without an established history of liver disease. While acetaminophen overdose has an antidote, that is N-acetylcysteine (NAC), when given acutely, most other causes of hepatic failure require an urgent liver transplant. In this paper, we report a case of cocaine-induced acute liver failure that was reversed with the administration of NAC. Our case began when a middle-aged male presented to the emergency department complaining of nausea, vomiting, fatigue, and confusion for the past three days. His past medical history was pertinent for a history of opioid use disorder and his physical exam was remarkable for somnolence, asterixis, and periumbilical ecchymoses. His initial lab results showed markedly elevated liver function tests, prolonged coagulation studies, and a urine drug screen that was positive for cocaine. During the patient’s interview, his vital signs became unstable. He was intubated for airway protection and transferred to a tertiary care facility for liver transplant evaluation with the diagnosis of cocaine-induced acute liver failure. There he received NAC, lactulose, rifaximin, and vasopressors. On day two of treatment, his clinical condition greatly improved, and he was extubated. He continued to receive NAC until day five when his liver function tests and coagulopathy improved enough to stop treatment. This case report highlights the clinical benefit of NAC in a case of cocaine-induced acute liver failure, improving the patient’s survival and eliminating his need for a liver transplant. Cureus 2023-07-08 /pmc/articles/PMC10407963/ /pubmed/37559860 http://dx.doi.org/10.7759/cureus.41579 Text en Copyright © 2023, Mitchell et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Internal Medicine
Mitchell, Mary C
Rogers, Cleon
A Case of Cocaine-Induced Acute Liver Failure Reversed With N-Acetylcysteine
title A Case of Cocaine-Induced Acute Liver Failure Reversed With N-Acetylcysteine
title_full A Case of Cocaine-Induced Acute Liver Failure Reversed With N-Acetylcysteine
title_fullStr A Case of Cocaine-Induced Acute Liver Failure Reversed With N-Acetylcysteine
title_full_unstemmed A Case of Cocaine-Induced Acute Liver Failure Reversed With N-Acetylcysteine
title_short A Case of Cocaine-Induced Acute Liver Failure Reversed With N-Acetylcysteine
title_sort case of cocaine-induced acute liver failure reversed with n-acetylcysteine
topic Internal Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10407963/
https://www.ncbi.nlm.nih.gov/pubmed/37559860
http://dx.doi.org/10.7759/cureus.41579
work_keys_str_mv AT mitchellmaryc acaseofcocaineinducedacuteliverfailurereversedwithnacetylcysteine
AT rogerscleon acaseofcocaineinducedacuteliverfailurereversedwithnacetylcysteine
AT mitchellmaryc caseofcocaineinducedacuteliverfailurereversedwithnacetylcysteine
AT rogerscleon caseofcocaineinducedacuteliverfailurereversedwithnacetylcysteine