| Coingestion of cyclooxygenase inhibitors can worsen severe paracetamol poisoning by middle-sized and small arteries vasoconstriction. | |
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MedLine Citation:
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PMID: 14513213 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: We report fatal cases of multifocal ischemic injuries occurring in patients awaiting liver transplantation after severe concomitant paracetamol and cyclooygenase inhibitors self-poisoning. DESIGN AND SETTING: Case report in an intensive care unit. PATIENTS: In addition to signs of acute liver failure with a systemic inflammatory response syndrome, these three previously healthy young women demonstrated cutaneous vasoconstriction. One patient displayed a sudden ST-segment elevation with ventricular fibrillation. INTERVENTIONS: Angiography, plasma endothelin concentrations measurements, and autopsy. RESULTS: Radiography showed diffuse vasospasm on mesenteric and renal arteries, transiently reversed by vasodilators. We measured tenfold higher plasma endothelin concentrations than in healthy controls. Autopsy revealed no atherosis (including coronary arteries); organs showed multifocal ischemic injuries without thrombosis. CONCLUSIONS: Such injuries subsequent to dramatic vasoconstriction suggest that cyclooygenase inhibition has specific deleterious vascular side effects once systemic inflammatory response syndrome is in progress during paracetamol poisoning. |
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Authors:
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Francis Schneider; Agnès Neuville; Ferhat Meziani; Carole Meyer; Parissa Assemi; Thierry Lavigne; Vincent Castelain |
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Publication Detail:
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Type: Case Reports; Journal Article; Research Support, Non-U.S. Gov't Date: 2003-09-26 |
Journal Detail:
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Title: Intensive care medicine Volume: 29 ISSN: 0342-4642 ISO Abbreviation: Intensive Care Med Publication Date: 2003 Nov |
Date Detail:
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Created Date: 2003-11-10 Completed Date: 2004-02-13 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 7704851 Medline TA: Intensive Care Med Country: United States |
Other Details:
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Languages: eng Pagination: 2090-3 Citation Subset: IM |
Affiliation:
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Service de Réanimation Médicale, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Avenue Molière, 67098, Strasbourg, France. Francis.Schneider@chru-strasbourg.fr |
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| MeSH Terms | |
Descriptor/Qualifier:
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Acetaminophen
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poisoning* Adult Alanine Transaminase / blood Analgesics, Non-Narcotic / poisoning* Angiography Anti-Inflammatory Agents, Non-Steroidal / poisoning* Arterioles Aspartate Aminotransferases / blood Case-Control Studies Cyclooxygenase Inhibitors / poisoning* Endothelins / blood Fatal Outcome Female Humans Intensive Care / methods Ischemia / chemically induced, diagnosis, metabolism, therapy Liver Failure, Acute / chemically induced*, diagnosis, metabolism, therapy Liver Transplantation Mesenteric Vascular Occlusion / chemically induced*, diagnosis, metabolism, therapy Overdose Renal Artery Obstruction / chemically induced*, diagnosis, metabolism, therapy Skin / blood supply Systemic Inflammatory Response Syndrome / chemically induced |
| Chemical | |
Reg. No./Substance:
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0/Analgesics, Non-Narcotic; 0/Anti-Inflammatory Agents, Non-Steroidal; 0/Cyclooxygenase Inhibitors; 0/Endothelins; 103-90-2/Acetaminophen; EC 2.6.1.1/Aspartate Aminotransferases; EC 2.6.1.2/Alanine Transaminase |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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