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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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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Jakes, Adam D
Banerjee, Anita
description 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
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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. 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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 &lt;11.1 mmol/L International normalised ratio 1.0 Venous blood gas pH 7.40; hydrogen carbonate 25.4 mmol/L; base excess 0.5 mmol/L 7.35-7.45; 22-26 mmol/L; −2.0-2.0 mmol/L Lactate 1.02 mmol/L &lt;2.0 mmol/L Autoimmune screen (antinuclear, antismooth muscle, antimitochondrial antibodies) Negative Abdominal ultrasonography Normal appearance of liver and kidneys.</description><subject>Abdomen</subject><subject>Acetaminophen - toxicity</subject><subject>Acetylcysteine</subject><subject>Adult</subject><subject>Aftercare</subject><subject>Analgesics</subject><subject>Analgesics, Non-Narcotic - toxicity</subject><subject>Antiemetics</subject><subject>Antiemetics - therapeutic use</subject><subject>Antinuclear antibodies</subject><subject>Blood tests</subject><subject>Diagnosis, Differential</subject><subject>Drug dosages</subject><subject>Female</subject><subject>Fluid Therapy - methods</subject><subject>Folic acid</subject><subject>Gynecology</subject><subject>Hepatitis</subject><subject>Humans</subject><subject>Hyperemesis Gravidarum - complications</subject><subject>Hyperemesis Gravidarum - diagnosis</subject><subject>Hyperemesis Gravidarum - drug therapy</subject><subject>Intravenous administration</subject><subject>Lactic acid</subject><subject>Liver</subject><subject>Liver Diseases - blood</subject><subject>Liver Diseases - etiology</subject><subject>Liver Function Tests - methods</subject><subject>Midwifery</subject><subject>Pain</subject><subject>Paracetamol</subject><subject>Patients</subject><subject>Poisoning</subject><subject>Pregnancy</subject><subject>Rehydration</subject><subject>Serology</subject><subject>Starvation</subject><subject>Thiamine</subject><subject>Toxicity</subject><subject>Treatment Outcome</subject><subject>Ultrasonic imaging</subject><subject>Underweight</subject><subject>Vomiting</subject><subject>Wernicke's encephalopathy</subject><subject>Withholding Treatment</subject><issn>1756-1833</issn><issn>1756-1833</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp1kEtLw0AUhQdRbKkFf4EEdOEmde7cZpJZSusLCm50PczjpqS0kzpphP57E1ofG1f3LL5zDvcwdgl8AoDyzm5WkyCn2QkbQp7JFArE0z96wMZNs-KcC8wLJbNzNsBeKRBDdjOnaMKSfLKuPikmZRvcrqpDUoVkG2kZTHD7C3ZWmnVD4-MdsffHh7fZc7p4fXqZ3S9Si6h2qTPFVBkB4MkqEpIMkRECHScplbW-LCTkIieORemhBOmdUw7QAtnMI47Y9SF3G-uPlpqdXtVtDF2lFhnPpyBQ8I66PVAu1k0TqdTbWG1M3Gvgul9Ed4vofpEOvToGtnZD_gf8_v-3sbf8G_MFZxRmUQ</recordid><startdate>20210331</startdate><enddate>20210331</enddate><creator>Jiwa, Afra</creator><creator>Jakes, Adam D</creator><creator>Banerjee, Anita</creator><general>BMJ Publishing Group LTD</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88I</scope><scope>8AF</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ASE</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FPQ</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>HCIFZ</scope><scope>K6X</scope><scope>K9.</scope><scope>KB0</scope><scope>LK8</scope><scope>M2O</scope><scope>M2P</scope><scope>M7P</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope></search><sort><creationdate>20210331</creationdate><title>Deranged liver function in pregnancy</title><author>Jiwa, Afra ; 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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 &lt;11.1 mmol/L International normalised ratio 1.0 Venous blood gas pH 7.40; hydrogen carbonate 25.4 mmol/L; base excess 0.5 mmol/L 7.35-7.45; 22-26 mmol/L; −2.0-2.0 mmol/L Lactate 1.02 mmol/L &lt;2.0 mmol/L Autoimmune screen (antinuclear, antismooth muscle, antimitochondrial antibodies) Negative Abdominal ultrasonography Normal appearance of liver and kidneys.</abstract><cop>England</cop><pub>BMJ Publishing Group LTD</pub><pmid>33789912</pmid><doi>10.1136/bmj.n645</doi></addata></record>
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source BMJ_英国医学会期刊
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
title Deranged liver function in pregnancy
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