Deranged liver function in pregnancy

Smaller liver volume of underweight patients can reduce paracetamol clearance—the British National Formulary states that risk of toxicity might be increased at therapeutic doses, particularly in patients weighing less than 50 kg.5 The level of serum paracetamol was below the treatment line, however,...

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Bibliographic Details
Published in:BMJ (Online) 2021-03, Vol.372, p.n645
Main Authors: Jiwa, Afra, Jakes, Adam D, Banerjee, Anita
Format: Article
Language:English
Subjects:
Abdomen
Acetaminophen - toxicity
Acetylcysteine
Adult
Aftercare
Analgesics
Analgesics, Non-Narcotic - toxicity
Antiemetics
Antiemetics - therapeutic use
Antinuclear antibodies
Blood tests
Diagnosis, Differential
Drug dosages
Female
Fluid Therapy - methods
Folic acid
Gynecology
Hepatitis
Humans
Hyperemesis Gravidarum - complications
Hyperemesis Gravidarum - diagnosis
Hyperemesis Gravidarum - drug therapy
Intravenous administration
Lactic acid
Liver
Liver Diseases - blood
Liver Diseases - etiology
Liver Function Tests - methods
Midwifery
Pain
Paracetamol
Patients
Poisoning
Pregnancy
Rehydration
Serology
Starvation
Thiamine
Toxicity
Treatment Outcome
Ultrasonic imaging
Underweight
Vomiting
Wernicke's encephalopathy
Withholding Treatment
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Summary:Smaller liver volume of underweight patients can reduce paracetamol clearance—the British National Formulary states that risk of toxicity might be increased at therapeutic doses, particularly in patients weighing less than 50 kg.5 The level of serum paracetamol was below the treatment line, however, and N-acetylcysteine was not required.67 When prescribing oral and intravenous paracetamol in pregnant women, use clinical judgment to adjust the dose according to bodyweight. Patient outcome The patient was admitted for further investigations (table 3), observation, antiemetics, and rehydration with intravenous crystalloid fluid.4 The paracetamol was stopped immediately as, given her weight, it was believed that this might be contributing to her deranged liver function. According to Royal College of Obstetricians and Gynaecologists’ guidelines, thiamine was prescribed on discharge (because of the risk of Wernicke’s encephalopathy in prolonged starvation), along with folic acid.4 If pain relief was needed, we advised a maximum dose of 500 mg paracetamol four times a day.Table 3 Results of further investigations Test Result Normal range Glucose 6.22 mmol/L
ISSN:1756-1833
1756-1833
DOI:10.1136/bmj.n645