Share this Article
Singapore Med J 2013; 54(2): e35-e37; http://dx.doi.org/10.11622/smedj.2013037
Regular paracetamol in severe dengue: a lethal combination?
Gan CS, Chong SY, Lum LC, Lee WS
Correspondence: Dr Way Seah Lee, leews@um.edu.my
ABSTRACT
An eight-month-old female infant with severe dengue disease, who was repeatedly given therapeutic paracetamol for severe dengue, developed fulminant liver failure with encephalopathy, gastrointestinal haemorrhage and severe coagulopathy. She responded to supportive measures and N-acetylcysteine infusion. This case highlights the potential danger of administering repeated therapeutic doses of paracetamol in childhood severe dengue disease with hepatitis.
Keywords: hepatitis, paracetamol, severe dengue
Singapore Med J 2013; 54(2): e35–e37; http://dx.doi.org/10.11622/smedj.2013037
REFERENCES
| 1. Guzman MG, Halstead SB, Artsob H, et al. Dengue: a continuing global threat. Nat Rev Microbiol 2010; 8(12 Suppl):S7-16. http://dx.doi.org/10.1038/nrmicro2460 | ||||
| 2. Smith DR, Khakpoor A. Involvement of the liver in dengue infections. Dengue Bull 2009; 33:75-86. | ||||
| 3. Chongsrisawat V, Hutagalung Y, Poovorawan Y. Liver function test results and outcomes in children with acute liver failure due to dengue infection. Southeast Asian J Trop Med Public Health 2009; 40:47-53. | ||||
| 4. Prakash O, Almas A, Jafri SM, et al. Severity of acute hepatitis and its outcome in patients with dengue fever in a tertiary care hospital Karachi, Pakistan (South Asia). BMC Gastroenterol 2010; 10:43. http://dx.doi.org/10.1186/1471-230X-10-43 | ||||
| 5. Ling LM, Wilder-Smith A, Leo YS. Fulminant hepatitis in dengue haemorrhagic fever. J Clin Virol 2007; 38:265-8. http://dx.doi.org/10.1016/j.jcv.2006.12.011 | ||||
| 6. Vijayalakshmi AM, Devaprasath S. Fulminant hepatic failure in primary dengue infection. Indian Pediatr 2010; 47:280. | ||||
| 7. World Health Organization. Dengue Guidelines for Diagnosis, Prevention and Control. Available at: whqlibdoc.who.int/publications/2009/9789241547871_eng.pdf. Accessed February 17, 2011. | ||||
| 8. Alonso EM, Squires RH, Whitington PF. Acute liver failure in children. In: Suchy FJ, Sokol RJ, Balistreri WF, eds: Liver Disease in Children, 3rd ed. New York: Cambridge University Press, 2007. http://dx.doi.org/10.1017/CBO9780511547409.007 | ||||
| 9. Daly FF, Fountain JS, Murray L, Graudins A, Buckley NA. Guidelines for the management of paracetamol poisoning in Australia and New Zealand. A consensus statement from clinical toxicologists consulting to the Australasian poisons information centres. Med J Aust 2008; 188:296-301. | ||||
| 10. Squires RH Jr, Shneider BL, Bucuvalas J, et al. Acute liver failure in children: the first 348 patients in the pediatric acute liver failure study group. J Pediatr 2006; 148:652-8. http://dx.doi.org/10.1016/j.jpeds.2005.12.051 | ||||
| 11. Mahadevan SB, McKiernan PJ, Davies P, Kelly DA. Paracetamol induced hepatotoxicity. Arch Dis Child 2006; 91:598-603. http://dx.doi.org/10.1136/adc.2005.076836 | ||||
| 12.Vazquez-Pichardo M, Rosales-Jimenez C, Rojas-Espinosa O, LopezMartinez I, Moreno-Altamirano MMB. Is liver damage dependent on the serotype of dengue virus? A study in Mexico. Dengue Bull 2006; 30:114-20. | ||||
| 13. Jorup-Ronstrom C, Beermann B, Wahlin-Boll E, Melander A, Britton S. Reduction of paracetamol and aspirin metabolism during viral hepatitis. Clin Pharmacokinet 1986; 11:250-6. http://dx.doi.org/10.2165/00003088-198611030-00006 | ||||
| 14.Maddox JF, Amuzie CJ, Li M, et al. Bacterial- and viral-induced inflammation increases sensitivity to acetaminophen hepatotoxicity. J Toxicol Environ Health A 2010; 73:58-73. http://dx.doi.org/10.1080/15287390903249057 | ||||