Way back in 2019, I posted an article on the state of medical care in the socialist paradise of Venezuela. Of course, as is natural with socialist medicine, conventional medical care provided by doctors and hospitals becomes hard to get and unrelieved pain and suffering forces ill people to treat themselves, sometimes with dire consequences.
As the situation deteriorated in Venezuela, physicians noted an increasing number of cases of acute liver failure, some due to overdosing with acetaminophen (Tylenol), some due to misuse or overuse of medicinal herbs. Of course, drugs—legal, illegal, or herbs—are not the only cause of acute liver failure; it can also occur due to numerous other causes. The fact that cases of acute liver failure increased in socialist Venezuela as the people’s access to competent medical care decreased suggests that the same will happen here sooner or later. Actually, Tylenol overdose is already the most common reason for acute liver failure in the United States, having surpassed hepatitis a few years ago.[1] About half of all acute liver failure cases are fatal.[2]
It’s a topic that is not addressed in any of my off-grid medicine texts. I thought we ought to learn about it because in the coming days people may resort to taking too much Tylenol to alleviate pain or combining it or formulations that contain it with alcohol. Or a child may happen upon a bottle of children’s chewables and eat the whole thing.
First off,
let’s distinguish between acute liver failure and chronic liver failure. Acute liver failure is the much less common
of the two conditions and occurs when the liver suddenly loses its ability to
function, such as what happens with a drug overdose or poisoning. Chronic liver
failure takes a while to develop, typically years, and is often the result of
alcoholism, hepatitis, or hereditary diseases.[3] Acute liver failure is considered a medical
emergency; chronic liver failure is not, unless something triggers rapid
conversion to acute liver failure.[4] While the causes for the two vary, the signs
and symptoms are the same, as is the diagnostic process.
CAUSES
· Acute liver failure
o Overuse of drugs including acetaminophen (#1 cause in the US)[5]
§ Some antibiotics, antidepressants, anti-seizure medications, antifungal drugs, synthetic hormones, medicinal herbs including comfrey, black cohosh, glucosamine, and green tea extract are also implicated
o Viral infections such as hepatitis B, Epstein-Barr, cytomegalovirus, herpes simplex virus[6]
o Viral hepatitis types A, B, and E are the most common causes in third-world countries[7]
o Genetic diseases
o Heatstroke[8]
o Poisonous mushrooms[9]
· Chronic liver failure
o Cirrhosis, due to any of the following
§ Alcoholism
§ Hepatitis
§ Non-alcoholic fatty liver disease
§ Bile duct diseases
§ Hereditary diseases
SIGNS AND SYMPTOMS
· Initial signs common to both acute and chronic liver failure in the early stages
o Diarrhea
o Discomfort on the right side, just below the ribs
o Fatigue
o Loss of appetite
o Nausea[10]
· Later signs and symptoms
o Confusion or other mental difficulties[11]
o Sleepiness
o Severe fatigue[12]
o Bruising and bleeding easily[13]
o Vomiting blood
o Accumulation of fluid in the abdomen, arms, and/or legs[14] [15]
· Additional signs and symptoms of acute liver failure
o Musty or sweet breath odor[16]
o Movement problems[17]
Definitive diagnosis is going to be difficult without modern technology to assist. First, a physician will ask for a medical history—any drug use, hepatitis (including looking for signs of hepatitis, jaundice, yellowing of the eyes, fatigue, abdominal pain). Then s/he will assess mental alertness. Tests like ultrasound, MRI, and CT scans normally used to identify acute liver failure simply may not be available.
TREATMENT
Physicians may use any of the following to treat liver failure depending on the cause:
- Acute liver failure
- o Activated charcoal and N-acetylcysteine if due to acetaminophen or herbal overdose[18]
- o N-acetylcysteine may also be used to treat other causes of acute liver failure[19] [20]
- o Monitoring for signs of hypoglycemia and treating if necessary[21] [22]
- o Intravenous fluids to maintain blood pressure[23]
- o Laxatives and/or enemas to flush toxins out[24]
- Chronic liver failure
RISK FACTORS
- Excessive acetaminophen use[32]
- Pre-existing medical conditions, including Epstein-Barr, cytomegalovirus, herpes simplex virus, hepatitis, Wilson’s disease[33]
- Malnourished patients[34]
- Previous or current alcoholism[35]
PREVENTION
- Reduce or eliminate alcohol consumption[36]
- Vaccinate against hepatitis B[37]
- Maintain a healthy weight and exercise[38]
- Follow dosage guidelines for all herbal and pharmaceutical medications, especially those containing acetaminophen[39]
Current medical practice involves managing the liver failure by treating the underlying cause with the hope of either reversing the damage, which is possible especially if damage is not due to cirrhosis, or buying time until a donor liver can be obtained for transplantation.
(I apologize for all the weird bullet points. It's a Blogger issue I can't figure out.)
Links to related posts:
Desperate Times Call for Desperate Measures
[1] William Bernal, et al., Acute liver failure, New England Journal of Medicine, 26 December 2013, https://www.nejm.org/doi/full/10.1056/NEJMra1208937 (accessed 2 May 2023).
[2] William Bernal, et al., Acute liver failure, New England Journal of Medicine, 26 December 2013, https://www.nejm.org/doi/full/10.1056/NEJMra1208937 (accessed 2 May 2023).
[3] Acute liver poisoning, Johns Hopkins Medicine, https://www.hopkinsmedicine.org/health/conditions-and-diseases/acute-liver-failure (accessed 1 May 2023).
[4] Liver failure, UChicago Medicine, https://www.uchicagomedicine.org/conditions-services/liver-diseases/liver-failure (accessed 2 May 2023).
[5] William Bernal, et al., Acute liver failure, New England Journal of Medicine, 26 December 2013, https://www.nejm.org/doi/full/10.1056/NEJMra1208937 (accessed 2 May 2023).
[6] William Bernal, et al., Acute liver failure, New England Journal of Medicine, 26 December 2013, https://www.nejm.org/doi/full/10.1056/NEJMra1208937 (accessed 2 May 2023).
[7] William Bernal, et al., Acute liver failure, New England Journal of Medicine, 26 December 2013, https://www.nejm.org/doi/full/10.1056/NEJMra1208937 (accessed 2 May 2023).
[8] William Bernal, et al., Acute liver failure, New England Journal of Medicine, 26 December 2013, https://www.nejm.org/doi/full/10.1056/NEJMra1208937 (accessed 2 May 2023).
[9] William Bernal, et al., Acute liver failure, New England Journal of Medicine, 26 December 2013, https://www.nejm.org/doi/full/10.1056/NEJMra1208937 (accessed 2 May 2023).
[10] Acute liver poisoning, Johns Hopkins Medicine, https://www.hopkinsmedicine.org/health/conditions-and-diseases/acute-liver-failure (accessed 1 May 2023).
[11] Liver failure, UChicago Medicine, https://www.uchicagomedicine.org/conditions-services/liver-diseases/liver-failure (accessed 2 May 2023).
[12] Liver failure, UChicago Medicine, https://www.uchicagomedicine.org/conditions-services/liver-diseases/liver-failure (accessed 2 May 2023).
[13] Liver failure, UChicago Medicine, https://www.uchicagomedicine.org/conditions-services/liver-diseases/liver-failure (accessed 2 May 2023).
[14] Acute liver poisoning, Johns Hopkins Medicine, https://www.hopkinsmedicine.org/health/conditions-and-diseases/acute-liver-failure (accessed 1 May 2023).
[15] Liver failure, UChicago Medicine, https://www.uchicagomedicine.org/conditions-services/liver-diseases/liver-failure (accessed 2 May 2023).
[16] Liver failure, Cleveland Clinic, https://my.clevelandclinic.org/health/diseases/17819-liver-failure (accessed 3 May 2023).
[17] Liver failure, Cleveland Clinic, https://my.clevelandclinic.org/health/diseases/17819-liver-failure (accessed 3 May 2023).
[18] E. Stournaras, et al., Herbal medicine-related hepatotoxicity, World Journal of Hepatology, 8 September 2015, Vol 7 No 19, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4561772/ (accessed 1 May 2023).
[19] Acute liver poisoning, Johns Hopkins Medicine, https://www.hopkinsmedicine.org/health/conditions-and-diseases/acute-liver-failure (accessed 1 May 2023).
[20] E. Stournaras, et al., Herbal medicine-related hepatotoxicity, World Journal of Hepatology, 8 September 2015, Vol 7 No 19, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4561772/ (accessed 1 May 2023).
[21] William Bernal, et al., Acute liver failure, New England Journal of Medicine, 26 December 2013, https://www.nejm.org/doi/full/10.1056/NEJMra1208937 (accessed 2 May 2023).
[22] Liver failure, Cleveland Clinic, https://my.clevelandclinic.org/health/diseases/17819-liver-failure (accessed 3 May 2023).
[23] Liver failure, Cleveland Clinic, https://my.clevelandclinic.org/health/diseases/17819-liver-failure (accessed 3 May 2023).
[24] Liver failure, Cleveland Clinic, https://my.clevelandclinic.org/health/diseases/17819-liver-failure (accessed 3 May 2023).
[25] Liver failure, Cleveland Clinic, https://my.clevelandclinic.org/health/diseases/17819-liver-failure (accessed 3 May 2023).
[26] Liver failure, UChicago Medicine, https://www.uchicagomedicine.org/conditions-services/liver-diseases/liver-failure (accessed 2 May 2023).
[27] Liver failure, Cleveland Clinic, https://my.clevelandclinic.org/health/diseases/17819-liver-failure (accessed 3 May 2023).
[28] Liver failure, UChicago Medicine, https://www.uchicagomedicine.org/conditions-services/liver-diseases/liver-failure (accessed 2 May 2023).
[29] Liver failure, Cleveland Clinic, https://my.clevelandclinic.org/health/diseases/17819-liver-failure (accessed 3 May 2023).
[30] Liver failure, Cleveland Clinic, https://my.clevelandclinic.org/health/diseases/17819-liver-failure (accessed 3 May 2023).
[31] Liver failure, Cleveland Clinic, https://my.clevelandclinic.org/health/diseases/17819-liver-failure (accessed 3 May 2023).
[32] Liver failure, Cleveland Clinic, https://my.clevelandclinic.org/health/diseases/17819-liver-failure (accessed 3 May 2023).
[33] Liver failure, Cleveland Clinic, https://my.clevelandclinic.org/health/diseases/17819-liver-failure (accessed 3 May 2023).
[34] William Bernal, et al., Acute liver failure, New England Journal of Medicine, 26 December 2013, https://www.nejm.org/doi/full/10.1056/NEJMra1208937 (accessed 2 May 2023).
[35] William Bernal, et al., Acute liver failure, New England Journal of Medicine, 26 December 2013, https://www.nejm.org/doi/full/10.1056/NEJMra1208937 (accessed 2 May 2023).
[36] Liver failure, Cleveland Clinic, https://my.clevelandclinic.org/health/diseases/17819-liver-failure (accessed 3 May 2023).
[37] Liver failure, Cleveland Clinic, https://my.clevelandclinic.org/health/diseases/17819-liver-failure (accessed 3 May 2023).
[38] Liver failure, Cleveland Clinic, https://my.clevelandclinic.org/health/diseases/17819-liver-failure (accessed 3 May 2023).
[39] Liver failure, Cleveland Clinic, https://my.clevelandclinic.org/health/diseases/17819-liver-failure (accessed 3 May 2023).
Please prep to avoid this! Remember, your liver can only handle so much at a time, be careful mixing herbals, alcohol, and Tylenol together! Also, experienced medical folks can guess liver issues just from looking at someone (and possibly their pee).
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