A case of acute liver failure with hepatic coma after administration of high-dose acetaminophen

Abstract

There are many reports about liver damage with the overdosing of Calonal®, an oral medicine of acetaminophen, but there are few reports with the overdosing of Aserio® which is an intravenous formulation. We experienced a case of acute liver failure with hepatic coma after the administration of high-dose Aserio® for pain control during the perioperative period. Severe liver damage was found three days after the administration of Aserio®, and drug-induced toxic liver injury was suspected from the laboratory data and clinical course. We started N-acetylcystein and the drug adsorption therapy. Since we recognized grade III of hepatic encephalopathy, we started high-flow continuous hemodiafiltration. These therapies were able to improve the liver damage and disturbance of consciousness immediately. In general, acute liver failure with hepatic coma due to drug intoxication has a low survival rate, and we need to pay attention to dosage regimen when administering Aserio®.