Acetaminophen Overdose causes Acute Liver Failure

Acetaminophen overdose causes acute liver failure.
Significant liver injury usually occurs with doses of >10 to 15 g, most frequently taken in a suicide attempt.
The liver injury is caused by toxic metabolites of acetaminophen formed by the microsomal cytochrome P-450-dependent drug-metabolizing system.
Because ethanol induces this cytochrome P-450 system, severe hepatotoxicity can be seen in alcoholics, even with lower dosages of acetaminophen.
N-acetylcysteine administered early after ingestion (i.e., <24 hours) reduces the severity of liver necrosis. Acetaminophen and its metabolites are not cleared by hemodialysis.
Survivors of acute acetaminophen toxicity usually recover completely without progressive or residual liver damage.

Differentiating Features of Food Poisoning

Staphylococcal food poisoning is manifested 2 to 6 hours after eating food (salad, potato salads) contaminated by a preformed enterotoxin.

Yersinia is most commonly associated with the ingestion of improperly cooked meat, but symptoms generally begin more than 1 day after ingestion of the contaminated food.

Symptoms resulting from L. monocytogenes also occur more than 24 hours after the ingestion of contaminated foods (milk, ice cream, and poultry).

V. vulnificus-associated food poisoning presents usually 24 to 48 hours after the ingestion of contaminated seafood (usually oysters). C. welchii is not associated with food poisoning. The two clostridia associated with food poisoning are C. perfringens and C. botulinum.

Serology of Hepatitis B

In the interpretation of results of hepatitis B serologic tests, the following facts should be considered:

during the incubation period (i.e., before the onset of clinical manifestations) HbsAg, HbeAg, and HBV DNA become detectable in the serum.

At the onset of clinical symptoms (e.g., jaundice), an increase in the serum transaminases antibodies occurs and antibodies to HBc become detectable (HBc antibodies).

HBc antibodies are IgM and thereafter IgG; these latter antibodies persist for years.
HBs antibodies become detectable late in convalescence.
A rise in HBs antibodies in combination with a loss of HbsAg, HbeAg, and HBV DNA indicate the presence of immunity to HBV.
HbeAg and HBV DNA are markers of active viral replication and thus indicate high infectivity.
The loss of HbeAg and appearance of anti-HbeAb indicates a less infective stage.

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