N-Acetylcysteine (NAC) for the Prevention of Liver Failure in Heat Injury-Mediated Ischemic Hepatitis

Military Medicine
Joshua S WillKatie L Westerfield

Abstract

Exertional Heat Illness with associated ischemic hepatitis (IH) is a common occurrence among military trainees; however, few specific therapies exist if unresponsive to appropriate supportive measures. A 27-year-old basic combat trainee presented with altered mental status, renal insufficiency, rhabdomyolysis, and a core temp of 107.9 °F after collapsing during a run, leading to the diagnosis of heat stroke. While the patient's azotemia and creatinine kinase levels rapidly improved with aggressive intravenous hydration, transaminases continued to increase to nearly 155 times the upper limit of normal. Further laboratory evaluation revealed coagulopathy and thrombocytopenia suggestive of acute liver failure (ALF). On hospital day three, the patient was started on N-acetylcysteine (NAC). Evaluation for infectious and autoimmune etiologies of ALF was unremarkable; thus, the patient's symptomatology was attributed to IH resulting from heat stroke. Liver function normalized on NAC. Heat Injury is common among US Army recruits and results in thousands of hospitalizations in recent years. IH is characterized by diffuse hepatocyte necrosis following an episode of hemodynamic instability, and is an established sequela of Heat Injury. Th...Continue Reading

References

Jun 21, 2002·The New England Journal of Medicine·Abderrezak Bouchama, James P Knochel
Sep 23, 2003·European Journal of Gastroenterology & Hepatology·Martin WagnerRudolf E Stauber
Jun 16, 2009·Gastroenterology·William M LeeUNKNOWN Acute Liver Failure Study Group
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Jan 28, 2017·Liver International : Official Journal of the International Association for the Study of the Liver·Brian C DavisUNKNOWN Acute Liver Failure Study Group

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Citations

Apr 30, 2020·Hepatology International·Hitoshi Maruyama, Shuichiro Shiina
Apr 16, 2020·Case Reports in Emergency Medicine·Bertram K WoitokGregor Lindner
Jul 21, 2020·Journal of Sports Sciences·Joanna MarlegaMarcin Fijalkowski
May 27, 2021·Antioxidants & Redox Signaling·Akshay Patel, Andras Perl

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