Biering Vanessa, Bellouard Ronan, Martin Maëlle, Dailly Éric, Monteil-Ganière Catherine, Le Carpentier Edouard Charles
Laboratoire de Pharmacologie Clinique, Centre Hospitalo-Universitaire (CHU) Nantes, Nantes, France.
Nantes Université, Centre Hospitalo-Universitaire (CHU) Nantes, Cibles et Médicaments des Infections et de l'Immunité, IIciMED, UR1155, Nantes, France.
Front Toxicol. 2025 Jan 15;6:1502716. doi: 10.3389/ftox.2024.1502716. eCollection 2024.
Cocaine intoxication and abuse is a worldwide problem that can be the cause of numerous acute medical complications, including severe acute hepatitis. Although these cases are scarce, they are extremely serious and may lead to liver transplantation or death. Management of toxic hepatitis, once the causative agent has been discontinued, is essentially symptomatic, based on clinical and biological monitoring and prevention of complications related to acute hepatitis.
We present a case of a 28-year-old woman admitted to the emergency department for acute hepatitis due to cocaine intoxication. In addition to a sharp rise in her liver enzymes, the patient also presented metabolic acidosis, renal failure, and rhabdomyolysis. Treatment consisted of administering N-acetylcysteine (NAC), dialysis, and additional supportive measures. An improvement in the liver function with a decrease in transaminases occurred after the NAC administration. The toxicokinetics of major cocaine metabolites and clinical chemistry concentrations were monitored.
In addition to the usual management measures for acute hepatitis, the administration of N-acetylcysteine should be investigated further, although it is currently used only in cases of acetaminophen acute toxic hepatitis.
可卡因中毒和滥用是一个全球性问题，可导致众多急性医学并发症，包括严重急性肝炎。尽管这些病例罕见，但极其严重，可能导致肝移植或死亡。一旦停用致病药物，中毒性肝炎的治疗基本上是对症治疗，基于临床和生物学监测以及预防与急性肝炎相关的并发症。
我们报告一例28岁女性因可卡因中毒入住急诊科并发急性肝炎的病例。除肝酶急剧升高外，患者还出现代谢性酸中毒、肾衰竭和横纹肌溶解。治疗包括给予N-乙酰半胱氨酸（NAC）、透析及其他支持措施。给予NAC后肝功能改善，转氨酶降低。监测了主要可卡因代谢物的毒代动力学和临床化学浓度。
除了急性肝炎的常规管理措施外，应进一步研究N-乙酰半胱氨酸的给药，尽管目前仅用于对乙酰氨基酚急性中毒性肝炎病例。
