Acetaminophen-related acute renal failure without fulminant liver failure

Abstract

Background: Our patient experienced acute renal failure but not fulminant hepatic failure from acetaminophen toxicity.

Objective: To review the clinical and laboratory characteristics of similar cases of acetaminophen nephrotoxicity.

Methods: A MEDLINE search and medical record search at two large teaching hospitals.

Results: We reviewed our index case, a patient at Jackson Memorial Hospital, and 34 additional patients with acetaminophen nephrotoxicity reported in the literature. Oliguria was present in 23 of 31 patients. There was no difference in peak serum creatinine levels between patients treated with N-acetylcysteine and those not treated. The onset of acute renal failure was from 2-5 days after overdose, and peak serum creatinine levels occurred 3-16 days (average 7.3 days) after overdose. Thirteen patients required hemodialysis; all but one were oliguric. Renal failure was spontaneously reversible in all patients.

Conclusion: Although uncommon, it is possible to have acute renal failure due to acetaminophen toxicity in the absence of fulminant hepatic failure.