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Management of non-acetaminophen-induced ALF

The first prospective, double-blind, randomized controlled study of acetylcysteine for the treatment of patients with non-acetaminophen-induced acute liver failure supports its use in patients in the early stages of liver failure. Emergency liver transplantation still has a fundamental role in the management of patients with the most severe form of this syndrome.

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References

  1. Prescott, L. F. et al. Intravenous N-acetylcysteine: the treatment of choice for paracetamol poisoning. BMJ ii, 1097–1100 (1979).

    Article  Google Scholar 

  2. Harrison, P. M., Keays, R., Bray, G. P., Alexander, G. J. M. & Williams, R. Improved outcome of paracetamol-induced fulminant hepatic failure by late administration of acetylcysteine. Lancet 335, 1572–1573 (1990).

    Article  CAS  PubMed  Google Scholar 

  3. Keays, R. et al. Intravenous acetylcysteine in paracetamol induced fulminant hepatic failure: a prospective controlled trial. BMJ 303, 1026–1029 (1991).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Harrison, P. M., Wendon, J. A., Gimson, A. E. S., Alexander, G. J. M. & Williams, R. Improvement by acetylcysteine of hemodynamics and oxygen transport in fulminant hepatic failure. N. Engl. J. Med. 324, 1852–1857 (1991).

    Article  CAS  PubMed  Google Scholar 

  5. Walsh, T. S., Hopton, P., Philips, B. J., Mackenzie, S. J. & Lee, A. The effect of N-acetylcysteine on oxygen transport and uptake in patients with fulminant hepatic failure. Hepatology 27, 1332–1340 (1998).

    Article  CAS  PubMed  Google Scholar 

  6. Lee, W. M. et al. Intravenous N-acetylcysteine improves transplant-free survival in early stage non-acetaminophen acute liver failure. Gastroenterology 137, 856–864 (2009).

    Article  CAS  PubMed  Google Scholar 

  7. Kortsalioudaki, C. et al. Safety and efficacy of N-acetylcysteine in children with non-acetaminophen-induced acute liver failure. Liver Transpl. 14, 25–30 (2008).

    Article  PubMed  Google Scholar 

  8. Yang, R., Miki, K., He, X., Killeen, M. E. & Fink, M. P. Prolonged treatment with N-acetylcysteine delays liver recovery from acetaminophen hepatotoxicity. Crit. Care doi:10.1186/cc7782.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Jimenez-Saenz, M. & Martinez-Sanchez, C. Green tea extracts and acute liver failure: the need for caution in their use and diagnostic assessment. Liver Transpl. 13, 1067 (2007).

    Article  PubMed  Google Scholar 

  10. Henderson, N. C. et al. Critical role of c-jun (NH2) terminal kinase in paracetamol-induced acute liver failure. Gut 56, 982–990 (2007).

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Roger Williams.

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The authors declare no competing financial interests.

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Riordan, S., Williams, R. Management of non-acetaminophen-induced ALF. Nat Rev Gastroenterol Hepatol 7, 75–77 (2010). https://doi.org/10.1038/nrgastro.2009.236

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