Document Detail


Coingestion of cyclooxygenase inhibitors can worsen severe paracetamol poisoning by middle-sized and small arteries vasoconstriction.
MedLine Citation:
PMID:  14513213     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Francis Schneider; Agnès Neuville; Ferhat Meziani; Carole Meyer; Parissa Assemi; Thierry Lavigne; Vincent Castelain
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Publication Detail:
Type:  Case Reports; Journal Article; Research Support, Non-U.S. Gov't     Date:  2003-09-26
Journal Detail:
Title:  Intensive care medicine     Volume:  29     ISSN:  0342-4642     ISO Abbreviation:  Intensive Care Med     Publication Date:  2003 Nov 
Date Detail:
Created Date:  2003-11-10     Completed Date:  2004-02-13     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2090-3     Citation Subset:  IM    
Affiliation:
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:
Acetaminophen / 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:
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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