Paracetamol as a Possible Cause of Fulminant Liver Failure

Two cases (a 40-year-old man and a 6-year-old child) are presented, in which deaths occurred with symptoms of fulminant liver failure. Mechanical cholaemia was excluded; however, steatosis (in both cases) and an inflammatory state (in the man) of the liver were ascertained. Although no hepatotoxical factor other than paracetamol was ascertained, it could not be unequivocally established as the cause of the fulminant liver failure as the interview was incomplete, and the results of toxicological examinations showed that the levels of the medicine were situated within the range of therapeutic concentrations, and also results of histological examinations did not show necrosis of the middle lobulated, which is characteristic for acute intoxication with large doses of paracetamol. In both cases, however, there were circumstances that considerably increased the risk of hepatotoxicity of paracetamol. In the child, gastrointestinal disturbances and a diet connected to them could have increased the hepatotoxic activity of the medicine. The occurrence of alcoholic-paracetamol syndrome in the man, on the other hand, could have been caused by protracted abuse of alcohol and a 2-day abstention before death.