Reactions 1477, p25 - 9 Nov 2013 S Paracetamol Intracranial hypertension secondary to acute liver failure: case report A 42-year-old woman developed intracranial hypertension secondary to acute liver failure while receiving paracetamol [acetaminophen]; she later died. The woman had presented with acute liver failure secondary to paracetamol toxicity [details of drug administration not stated]. She was transferred to an institution, and her mental status quickly deteriorated. CT showed development of cerebral oedema, and hepatic encephalopathy was suspected. The woman was managed with hyperosmolar therapy, rifaximin, propofol, lactulose, hypothermia and paralytics; however, she developed refractory intracranial hypertension. Following treatment with indometacin, her intracranial pressure (ICP) immediately decreased from 30mm Hg to 10mmg Hg. Her ICP remained at goal level for approximately 4 hours and 43 minutes, facilitating liver transplantation work- up. She received one additional dose of indometacin, allowing for completion of necessary imaging. On hospital day 6, she underwent a successful liver transplant; however, she continued to experience intracranial hypertension and multiple unspecified complications. On postoperative day 12, she died due to cardiovascular collapse. Author comment: "A 42-year-old female transferred to our institution from an outside hospital after presenting with acute liver failure secondary to acetaminophen toxicity." Lasak-Myall T, et al. The use of intravenous indomethacin for urgent treatment of refractory intracranial hypertension secondary to acute hepatic failure. Neurocritical Care 19 (Suppl.): S312 abstr. 277, No. 1, Sep 2013. Available from: URL: http://dx.doi.org/10.1007/s12028-013-9895-1 - USA 803095518 1 Reactions 9 Nov 2013 No. 1477 0114-9954/13/1477-0001/$14.95 Adis © 2013 Springer International Publishing AG. All rights reserved

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Reactions 1477, p25 - 9 Nov 2013

SParacetamol

Intracranial hypertension secondary to acute liverfailure: case report

A 42-year-old woman developed intracranial hypertensionsecondary to acute liver failure while receiving paracetamol[acetaminophen]; she later died.

The woman had presented with acute liver failure secondaryto paracetamol toxicity [details of drug administration notstated]. She was transferred to an institution, and her mentalstatus quickly deteriorated. CT showed development ofcerebral oedema, and hepatic encephalopathy was suspected.

The woman was managed with hyperosmolar therapy,rifaximin, propofol, lactulose, hypothermia and paralytics;however, she developed refractory intracranial hypertension.Following treatment with indometacin, her intracranialpressure (ICP) immediately decreased from 30mm Hg to10mmg Hg. Her ICP remained at goal level for approximately4 hours and 43 minutes, facilitating liver transplantation work-up. She received one additional dose of indometacin, allowingfor completion of necessary imaging. On hospital day 6, sheunderwent a successful liver transplant; however, shecontinued to experience intracranial hypertension andmultiple unspecified complications. On postoperative day 12,she died due to cardiovascular collapse.

Author comment: "A 42-year-old female transferred to ourinstitution from an outside hospital after presenting withacute liver failure secondary to acetaminophen toxicity."Lasak-Myall T, et al. The use of intravenous indomethacin for urgent treatment ofrefractory intracranial hypertension secondary to acute hepatic failure.Neurocritical Care 19 (Suppl.): S312 abstr. 277, No. 1, Sep 2013. Available from:URL: http://dx.doi.org/10.1007/s12028-013-9895-1 - USA 803095518