Recognition of Acetaminophen Hepatotoxicity in Chronic Alcoholics

Purpose: To evaluate a chronic alcoholic who is takes acetaminophen for possible hepatic injury.

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Evaluation

Are you evaluating a chronic alcoholic who takes acetaminophen?

Yes

Initial AST

Upper limit of reference range for AST

Initial ALT

Upper limit of reference range for ALT

Initial prothrombin time

seconds

Initial serum acetaminophen

AST in U/L 24-48 hours later

ALT in U/L 24-48 hours later

Prothrombin time 24-48 hours later

seconds

Results

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Results Interpretation and Description References Next Steps

Data complete?

Evaluation appropriate?

Initial AST-to-ALT ratio

Subsequent AST-to-ALT ratio

C/w normal?

C/w alcoholic hepatitis?

C/w acetaminophen and alcohol injury?

C/w early acetaminophen overdosage?

C/w later acetaminophen overdosage?

Caution: A qualified health practitioner should verify all results.
Keep patient data confidential and comply with all legal requirements.

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Interpretation and Description

References

Next Steps in Evaluation

Diagnosis

Risk Factors
Clinical Diagnosis, Including Family History For Genetics
Imaging Studies
- Intrahepatic Cholestasis Associated with Alcoholic Liver Disease
Laboratory Tests
Other Testing
Criteria For Diagnosis
- Discriminant Function of Maddrey et al and the Modified Discriminant Function of Carithers et al for Steroid Therapy in Severe Alcoholic Hepatitis
- Criteria for Severe Alcoholic Hepatitis
Severity, Prognosis, Stage
Complications
- Discriminant Function of Maddrey et al and the Modified Discriminant Function of Carithers et al for Steroid Therapy in Severe Alcoholic Hepatitis
Differential Diagnosis And Mimics, Red Flags
- ANI Model for Evaluating Patient with Steatohepatitis

Therapy

Selection

Monitoring

Disease Progression
- Alcoholic Liver Disease | Combined Clinical & Laboratory Index (CCLI)

Specialty

Gastroenterology
Toxicology

Objective

clinical diagnosis
including family history for genetics
laboratory tests
differential diagnosis and mimics
red flags

ICD-10

K70.9 - Alcoholic liver disease, unspecified
K71.9 - Toxic liver disease, unspecified
F10.2 - Mental and behavioural disorders due to use of alcohol, dependence syndrome

Info

Purpose: To evaluate a chronic alcoholic who is takes acetaminophen for possible hepatic injury.

Specialty: Gastroenterology, Toxicology

Objective: clinical diagnosis, including family history for genetics, laboratory tests, differential diagnosis and mimics, red flags

ICD-10: K70.9, K71.9, F10.2,

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