Hassen Getaw Worku, Dhaliwal Amaninder, Jenninigs Catherine Ann, Kalantari Hossein
NYMC, Metropolitan Hospital Center, Department of Emergency Medicine, New York, NY 10029, USA.
University of Nebraska, Department of Gastroenterology, Nebraska, USA.
Case Rep Emerg Med. 2018 Sep 26;2018:4393064. doi: 10.1155/2018/4393064. eCollection 2018.
Acute liver failure can result from acetaminophen overdose, viral infection, toxins, and other disease conditions. Liver transplant is available in limited fashion and the criteria are strict as to who should get an available liver. N- Acetyl Cysteine (NAC) has been used in non-acetaminophen induced liver failure with success. Here we report a case of acute liver failure from cocaethylene that was reversed with NAC along with other medical therapy.
A 50-year-old female patient presented to the Emergency Department (ED) with a two-day history of coffee ground vomiting and hematemesis. She reported occasional substance abuse and heavy alcoholism. She reported shortness of breath and chest pain from the recurrent forceful vomiting. The rest of the review of systems was unremarkable except a fall from intoxication. Physical examination revealed anicteric conjunctiva and nontender abdomen and her vital signs were within normal limits. Initial blood work revealed acute liver and renal failure. The patient was started with general medical management and liver transplant service rejected the case due to active substance abuse. She underwent brief hemodialysis and was started on NAC. Over the course of her hospital stay her liver function and kidney function improved significantly and patient was discharged to home.
In cases where liver transplant is not an option for various reasons including active substance abuse, a trial of N-Acetyl Cysteine may be beneficial and should be considered in the Emergency Department.
急性肝衰竭可由对乙酰氨基酚过量、病毒感染、毒素及其他疾病状况引起。肝移植的应用有限，且对于谁应接受可用肝脏的标准很严格。N - 乙酰半胱氨酸（NAC）已成功用于非对乙酰氨基酚所致的肝衰竭。在此，我们报告一例因可卡因乙烯醚导致的急性肝衰竭病例，该病例通过NAC及其他药物治疗得以逆转。
一名50岁女性患者因两天来咖啡渣样呕吐和呕血就诊于急诊科。她自述偶尔有药物滥用及严重酗酒史。她称因反复剧烈呕吐出现呼吸急促和胸痛。除因中毒摔倒外，其余系统回顾无异常。体格检查显示结膜无黄疸、腹部无压痛，生命体征正常。初始血液检查显示急性肝衰竭和肾衰竭。患者开始接受一般内科治疗，因存在药物滥用，肝移植服务拒绝接收该病例。她接受了短期血液透析并开始使用NAC。在住院期间，她的肝功能和肾功能显著改善，患者出院回家。
在因包括药物滥用等各种原因无法进行肝移植的情况下，尝试使用N - 乙酰半胱氨酸可能有益，急诊科应予以考虑。
