Polysubstance-Induced Hepatotoxicity and the Role of Supportive Management

Abstract

With the continued rise of polysubstance use throughout the country, it has been shown to affect a multitude of organ systems. Drug-induced liver injury (DILI) has been widely documented in its association with salicylates or acetaminophen and the utility of using N-acetylcysteine (NAC) for its hepatoprotective effects. However, DILI caused by illicit drug use and guideline-directed management has had little research. We present the case of a 29-year-old female who presented with altered mental status. She was found to have a concomitant liver injury and was treated supportively without the use of NAC, with gradual improvement.

Keywords: altered mental status; cocaine; drug-induced liver injury; nac-n acetyl cysteine; polysubstance use; supportive care and symptom management.

Figure 1. Computed tomography head showing lateral right frontal lobe encephalomalacia (circled)

Figure 2. Computed tomography head showing lateral right temporal encephalomalacia

Figure 3. Right upper quadrant ultrasound demonstrating normal echogenicity of the liver with no focal hepatic mass lesions identified

Figure 4. Electrocardiogram showing normal sinus rhythm, heart rate 124 bpm

bpm: beat per minute