Unrecognized acetaminophen toxicity as a cause of indeterminate acute liver failure
Despite extensive investigations, the cause of liver injury in 14% of patients with acute liver failure remains unknown (indeterminate). In a pilot study using a novel assay, highly specific acetaminophen‐cysteine adducts were detected in 7 of 36 indeterminate patients (19%). To extend these observa...
Saved in:
| Published in | Hepatology (Baltimore, Md.) Vol. 53; no. 2; pp. 567 - 576 |
|---|---|
| Main Authors | , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Hoboken
Wiley Subscription Services, Inc., A Wiley Company
01.02.2011
Wiley Wolters Kluwer Health, Inc |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0270-9139 1527-3350 1527-3350 |
| DOI | 10.1002/hep.24060 |
Cover
| Abstract | Despite extensive investigations, the cause of liver injury in 14% of patients with acute liver failure remains unknown (indeterminate). In a pilot study using a novel assay, highly specific acetaminophen‐cysteine adducts were detected in 7 of 36 indeterminate patients (19%). To extend these observations, sera from 110 subjects enrolled in the Acute Liver Failure Study Group registry with indeterminate acute liver failure were analyzed with a similar but more efficient and sensitive adduct assay. As positive controls, another 199 patients with known or presumed acetaminophen‐induced liver failure were assessed for the presence and quantity of adducts. Clinical, laboratory, and outcome data were compared for the two groups. On the basis of previous data for known therapeutic exposures and acetaminophen overdoses, an adduct concentration ≥1.0 nmol/mL of serum indicated a definite acetaminophen overdose. Among the 110 indeterminate cases, 18% had assay values ≥1.0 with a median level of 9.2 nmol/mL; 94.5% of the positive controls (known acetaminophen cases) had values ≥1.0 nmol/mL. Regardless of the initial diagnosis, subjects with elevated adduct levels demonstrated the clinical profile and hyperacute biochemical injury pattern associated with acetaminophen overdose: a predominance of female gender, very high aminotransferase levels, and low bilirubin levels. Conclusion: These data confirm and extend previous observations regarding the high (18%) prevalence of unrecognized or uncertain acetaminophen toxicity among subjects with indeterminate acute liver failure. N‐Acetylcysteine use was limited in this group, presumably because of the lack of a specific diagnosis of acetaminophen toxicity. (HEPATOLOGY 2011;53:567‐576.) |
|---|---|
| AbstractList | Despite extensive investigations, the cause of liver injury in 14% of patients with acute liver failure remains unknown (indeterminate). In a pilot study using a novel assay, highly specific acetaminophen-cysteine adducts were detected in 7 of 36 indeterminate patients (19%). To extend these observations, sera from 110 subjects enrolled in the Acute Liver Failure Study Group registry with indeterminate acute liver failure were analyzed with a similar but more efficient and sensitive adduct assay. As positive controls, another 199 patients with known or presumed acetaminophen-induced liver failure were assessed for the presence and quantity of adducts. Clinical, laboratory, and outcome data were compared for the two groups. On the basis of previous data for known therapeutic exposures and acetaminophen overdoses, an adduct concentration ≥1.0 nmol/mL of serum indicated a definite acetaminophen overdose. Among the 110 indeterminate cases, 18% had assay values ≥1.0 with a median level of 9.2 nmol/mL; 94.5% of the positive controls (known acetaminophen cases) had values ≥1.0 nmol/mL. Regardless of the initial diagnosis, subjects with elevated adduct levels demonstrated the clinical profile and hyperacute biochemical injury pattern associated with acetaminophen overdose: a predominance of female gender, very high aminotransferase levels, and low bilirubin levels.UNLABELLEDDespite extensive investigations, the cause of liver injury in 14% of patients with acute liver failure remains unknown (indeterminate). In a pilot study using a novel assay, highly specific acetaminophen-cysteine adducts were detected in 7 of 36 indeterminate patients (19%). To extend these observations, sera from 110 subjects enrolled in the Acute Liver Failure Study Group registry with indeterminate acute liver failure were analyzed with a similar but more efficient and sensitive adduct assay. As positive controls, another 199 patients with known or presumed acetaminophen-induced liver failure were assessed for the presence and quantity of adducts. Clinical, laboratory, and outcome data were compared for the two groups. On the basis of previous data for known therapeutic exposures and acetaminophen overdoses, an adduct concentration ≥1.0 nmol/mL of serum indicated a definite acetaminophen overdose. Among the 110 indeterminate cases, 18% had assay values ≥1.0 with a median level of 9.2 nmol/mL; 94.5% of the positive controls (known acetaminophen cases) had values ≥1.0 nmol/mL. Regardless of the initial diagnosis, subjects with elevated adduct levels demonstrated the clinical profile and hyperacute biochemical injury pattern associated with acetaminophen overdose: a predominance of female gender, very high aminotransferase levels, and low bilirubin levels.These data confirm and extend previous observations regarding the high (18%) prevalence of unrecognized or uncertain acetaminophen toxicity among subjects with indeterminate acute liver failure. N-Acetylcysteine use was limited in this group, presumably because of the lack of a specific diagnosis of acetaminophen toxicity.CONCLUSIONThese data confirm and extend previous observations regarding the high (18%) prevalence of unrecognized or uncertain acetaminophen toxicity among subjects with indeterminate acute liver failure. N-Acetylcysteine use was limited in this group, presumably because of the lack of a specific diagnosis of acetaminophen toxicity. Despite extensive investigations, the cause of liver injury in 14% of patients with acute liver failure remains unknown (indeterminate). In a pilot study using a novel assay, highly specific acetaminophen-cysteine adducts were detected in 7 of 36 indeterminate patients (19%). To extend these observations, sera from 110 subjects enrolled in the Acute Liver Failure Study Group registry with indeterminate acute liver failure were analyzed with a similar but more efficient and sensitive adduct assay. As positive controls, another 199 patients with known or presumed acetaminophen-induced liver failure were assessed for the presence and quantity of adducts. Clinical, laboratory, and outcome data were compared for the two groups. On the basis of previous data for known therapeutic exposures and acetaminophen overdoses, an adduct concentration ≥1.0 nmol/mL of serum indicated a definite acetaminophen overdose. Among the 110 indeterminate cases, 18% had assay values ≥1.0 with a median level of 9.2 nmol/mL; 94.5% of the positive controls (known acetaminophen cases) had values ≥1.0 nmol/mL. Regardless of the initial diagnosis, subjects with elevated adduct levels demonstrated the clinical profile and hyperacute biochemical injury pattern associated with acetaminophen overdose: a predominance of female gender, very high aminotransferase levels, and low bilirubin levels. Conclusion: These data confirm and extend previous observations regarding the high (18%) prevalence of unrecognized or uncertain acetaminophen toxicity among subjects with indeterminate acute liver failure. N-Acetylcysteine use was limited in this group, presumably because of the lack of a specific diagnosis of acetaminophen toxicity. (HEPATOLOGY 2011;53:567-576.) Despite extensive investigations, the cause of liver injury in 14% of patients with acute liver failure remains unknown (indeterminate). In a pilot study using a novel assay, highly specific acetaminophen-cysteine adducts were detected in 7 of 36 indeterminate patients (19%). To extend these observations, sera from 110 subjects enrolled in the Acute Liver Failure Study Group registry with indeterminate acute liver failure were analyzed with a similar but more efficient and sensitive adduct assay. As positive controls, another 199 patients with known or presumed acetaminophen-induced liver failure were assessed for the presence and quantity of adducts. Clinical, laboratory, and outcome data were compared for the two groups. On the basis of previous data for known therapeutic exposures and acetaminophen overdoses, an adduct concentration greater than or equal to 1.0 nmol/mL of serum indicated a definite acetaminophen overdose. Among the 110 indeterminate cases, 18% had assay values greater than or equal to 1.0 with a median level of 9.2 nmol/mL; 94.5% of the positive controls (known acetaminophen cases) had values greater than or equal to 1.0 nmol/mL. Regardless of the initial diagnosis, subjects with elevated adduct levels demonstrated the clinical profile and hyperacute biochemical injury pattern associated with acetaminophen overdose: a predominance of female gender, very high aminotransferase levels, and low bilirubin levels. Conclusion: These data confirm and extend previous observations regarding the high (18%) prevalence of unrecognized or uncertain acetaminophen toxicity among subjects with indeterminate acute liver failure. N-Acetylcysteine use was limited in this group, presumably because of the lack of a specific diagnosis of acetaminophen toxicity. (HEPATOLOGY 2011; 53:567-576.) Despite extensive investigations, the cause of liver injury in 14% of patients with acute liver failure remains unknown (indeterminate). In a pilot study using a novel assay, highly specific acetaminophen-cysteine adducts were detected in 7 of 36 indeterminate patients (19%). To extend these observations, sera from 110 subjects enrolled in the Acute Liver Failure Study Group registry with indeterminate acute liver failure were analyzed with a similar but more efficient and sensitive adduct assay. As positive controls, another 199 patients with known or presumed acetaminophen-induced liver failure were assessed for the presence and quantity of adducts. Clinical, laboratory, and outcome data were compared for the two groups. On the basis of previous data for known therapeutic exposures and acetaminophen overdoses, an adduct concentration ≥1.0 nmol/mL of serum indicated a definite acetaminophen overdose. Among the 110 indeterminate cases, 18% had assay values ≥1.0 with a median level of 9.2 nmol/mL; 94.5% of the positive controls (known acetaminophen cases) had values ≥1.0 nmol/mL. Regardless of the initial diagnosis, subjects with elevated adduct levels demonstrated the clinical profile and hyperacute biochemical injury pattern associated with acetaminophen overdose: a predominance of female gender, very high aminotransferase levels, and low bilirubin levels. These data confirm and extend previous observations regarding the high (18%) prevalence of unrecognized or uncertain acetaminophen toxicity among subjects with indeterminate acute liver failure. N-Acetylcysteine use was limited in this group, presumably because of the lack of a specific diagnosis of acetaminophen toxicity. |
| Author | James, Laura P. Khandelwal, Niraj Sanders, Corron Larson, Anne M. Lee, William M. |
| AuthorAffiliation | 1 Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas 2 Department of Pharmacology, University of Arkansas for Medical Sciences & Arkansas Children’s Hospital Research Institute, Little Rock, Arkansas 3 Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, Texas |
| AuthorAffiliation_xml | – name: 1 Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas – name: 3 Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, Texas – name: 2 Department of Pharmacology, University of Arkansas for Medical Sciences & Arkansas Children’s Hospital Research Institute, Little Rock, Arkansas |
| Author_xml | – sequence: 1 givenname: Niraj surname: Khandelwal fullname: Khandelwal, Niraj – sequence: 2 givenname: Laura P. surname: James fullname: James, Laura P. – sequence: 3 givenname: Corron surname: Sanders fullname: Sanders, Corron – sequence: 4 givenname: Anne M. surname: Larson fullname: Larson, Anne M. – sequence: 5 givenname: William M. surname: Lee fullname: Lee, William M. email: william.lee@utsouthwestern.edu |
| BackLink | http://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=23883920$$DView record in Pascal Francis https://www.ncbi.nlm.nih.gov/pubmed/21274877$$D View this record in MEDLINE/PubMed |
| BookMark | eNp90l9rFDEQAPAgFXutPvgFZEFK9WHbSbL5sy8FKdUKBQXtc0izs72UveRMds-en97UO6sW7EvmIb8ZhpnZIzshBiTkJYUjCsCO57g8Yg1IeEJmVDBVcy5gh8yAKahbyttdspfzDQC0DdPPyC6jTDVaqRn5chkSungd_A_sKutwtAsf4nKOoRrjrXd-XFc2V7ZydspYxb7yocMRU2F2xJIylXfwK0xVb_0wJXxOnvZ2yPhiG_fJ5fuzr6fn9cWnDx9P313UTigKteiobBjvOlBXVDmhpUDalqChVVRCX35bJ5hwVmHneui04J2TimnHqWr4PjnZ1F1OV4siMIzJDmaZ_MKmtYnWm39_gp-b67gynIFuQZQCh9sCKX6bMI9m4bPDYbAB45SNbjSnonRZ5JtHJVVKSgmMtoW-fkBv4pRCGURRUmrGlFRFvfq79_umf2-mgIMtsNnZoU82OJ__OK41bxkU93bjXIo5J-zvCQVzdx2mXIf5dR3FHj-wZb129PFuPH54LOO7H3D9_9Lm_OzzJuMntKXJgQ |
| CODEN | HPTLD9 |
| CitedBy_id | crossref_primary_10_1007_s11356_019_05704_y crossref_primary_10_1002_hep_26001 crossref_primary_10_1007_s13181_014_0431_2 crossref_primary_10_1053_j_gastro_2013_12_032 crossref_primary_10_1177_0885066615609271 crossref_primary_10_1038_s41598_017_11811_y crossref_primary_10_3390_bios13070726 crossref_primary_10_3389_fphar_2022_828565 crossref_primary_10_1016_j_medcle_2015_07_005 crossref_primary_10_1186_1472_6904_12_11 crossref_primary_10_1586_17474124_2016_1127756 crossref_primary_10_1166_sl_2020_4276 crossref_primary_10_1111_bcp_12831 crossref_primary_10_1016_j_mri_2011_09_023 crossref_primary_10_1016_j_cld_2019_09_005 crossref_primary_10_1016_j_medcli_2015_07_007 crossref_primary_10_1097_MOT_0b013e328346c8ee crossref_primary_10_1002_lt_24403 crossref_primary_10_1111_j_1478_3231_2011_02655_x crossref_primary_10_1002_hep_29917 crossref_primary_10_1124_jpet_117_242107 crossref_primary_10_1016_j_biopha_2017_05_037 crossref_primary_10_3389_fphar_2022_934467 crossref_primary_10_1007_s13181_019_00705_2 crossref_primary_10_1039_c3ay26614a crossref_primary_10_1055_s_0042_1755274 crossref_primary_10_1016_j_jhep_2019_10_030 crossref_primary_10_1056_NEJMra1202561 crossref_primary_10_1016_j_cld_2013_07_002 crossref_primary_10_1016_j_cld_2013_07_005 crossref_primary_10_1016_j_foodres_2020_109461 crossref_primary_10_1016_j_cld_2013_07_001 crossref_primary_10_1080_1354750X_2017_1410857 crossref_primary_10_1124_dmd_121_000459 crossref_primary_10_1016_j_dyepig_2022_110341 crossref_primary_10_1016_j_bpg_2012_01_014 crossref_primary_10_1007_s40264_021_01109_4 crossref_primary_10_1371_journal_pcbi_1009053 crossref_primary_10_1177_0009922812456592 crossref_primary_10_1007_s11095_024_03800_4 crossref_primary_10_1007_s12072_017_9793_2 crossref_primary_10_1056_NEJMra1208937 crossref_primary_10_1097_MJT_0b013e318250f829 crossref_primary_10_1371_journal_pone_0131010 crossref_primary_10_3390_ijms18040803 crossref_primary_10_1007_s10620_024_08602_7 crossref_primary_10_14309_ajg_0000000000002941 crossref_primary_10_1002_ejp_621 crossref_primary_10_1007_s13181_015_0484_x crossref_primary_10_1038_ajg_2017_98 crossref_primary_10_1016_j_intimp_2017_06_027 crossref_primary_10_1002_lt_24347 crossref_primary_10_1016_j_jhep_2014_12_016 crossref_primary_10_3109_15563650_2015_1134798 crossref_primary_10_1080_03602532_2024_2388203 crossref_primary_10_1097_HEP_0000000000000458 crossref_primary_10_1111_hepr_12483 crossref_primary_10_1124_jpet_112_202010 crossref_primary_10_1016_j_jhep_2011_12_019 crossref_primary_10_1007_s13181_015_0476_x crossref_primary_10_32749_nucleodoconhecimento_com_br_health_assessing_acetaminophen crossref_primary_10_1186_s40064_016_3240_z crossref_primary_10_1016_j_cld_2018_01_006 crossref_primary_10_1016_j_cld_2018_01_007 crossref_primary_10_2165_11633010_000000000_00000 crossref_primary_10_1080_17425255_2023_2259787 crossref_primary_10_1093_pch_16_9_544 crossref_primary_10_1097_MPG_0000000000001441 crossref_primary_10_3923_ijp_2016_851_862 crossref_primary_10_1016_j_jhep_2013_02_010 crossref_primary_10_1016_j_annfar_2013_03_004 crossref_primary_10_1016_S0140_6736_19_31894_X crossref_primary_10_1016_j_cgh_2016_09_007 crossref_primary_10_3390_ijms17040476 crossref_primary_10_1172_jci_insight_149276 crossref_primary_10_1002_hep_27266 crossref_primary_10_1038_nrgastro_2012_34 crossref_primary_10_1111_apt_14566 crossref_primary_10_1586_17512433_2014_889564 crossref_primary_10_1124_dmd_121_000732 crossref_primary_10_1002_cld_984 crossref_primary_10_1007_s00228_012_1410_7 crossref_primary_10_3390_ijms17010014 crossref_primary_10_1002_advs_202001129 crossref_primary_10_1007_s10620_022_07524_6 crossref_primary_10_1097_MPG_0000000000000814 crossref_primary_10_1002_lt_26187 crossref_primary_10_1016_j_cgh_2019_01_040 crossref_primary_10_1016_j_mayocp_2013_09_016 crossref_primary_10_1097_01_EHX_0000424249_68676_a3 crossref_primary_10_1016_j_fct_2018_12_002 crossref_primary_10_2217_bmm_13_150 crossref_primary_10_1016_j_cld_2017_06_002 crossref_primary_10_1111_j_1365_2036_2012_05097_x crossref_primary_10_1016_j_jcmgh_2017_01_008 crossref_primary_10_1517_17425255_2011_577415 crossref_primary_10_1016_j_cgh_2020_04_025 crossref_primary_10_1124_dmd_113_053546 crossref_primary_10_1016_j_comptc_2012_12_004 crossref_primary_10_1002_hep_28649 crossref_primary_10_1097_MPG_0000000000001459 crossref_primary_10_1007_s00204_015_1519_4 crossref_primary_10_1002_ccr3_4037 |
| Cites_doi | 10.7326/0003-4819-137-12-200212170-00007 10.1053/j.gastro.2006.01.033 10.1097/01.CCM.0000287592.94554.5F 10.1542/peds.55.6.871 10.1016/0016-5085(89)90081-4 10.1007/s10620-005-9061-5 10.1542/peds.2006-0069 10.1124/dmd.108.026195 10.1016/S0022-3565(25)23630-8 10.1016/0041-008X(90)90174-S 10.1002/lt.21567 10.1053/j.gastro.2009.06.006 10.1053/jhep.2001.23065 10.1086/379216 10.1124/dmd.30.4.446 10.1002/hep.20948 10.1053/jhep.2001.22172 10.1038/clpt.2008.190 |
| ContentType | Journal Article |
| Copyright | Copyright © 2010 American Association for the Study of Liver Diseases 2015 INIST-CNRS Copyright © 2010 American Association for the Study of Liver Diseases. |
| Copyright_xml | – notice: Copyright © 2010 American Association for the Study of Liver Diseases – notice: 2015 INIST-CNRS – notice: Copyright © 2010 American Association for the Study of Liver Diseases. |
| CorporateAuthor | and the Acute Liver Failure Study Group Acute Liver Failure Study Group |
| CorporateAuthor_xml | – name: and the Acute Liver Failure Study Group – name: Acute Liver Failure Study Group |
| DBID | AAYXX CITATION IQODW CGR CUY CVF ECM EIF NPM 7T5 7TM 7TO 7U9 H94 K9. 7X8 5PM |
| DOI | 10.1002/hep.24060 |
| DatabaseName | CrossRef Pascal-Francis Medline MEDLINE MEDLINE (Ovid) MEDLINE MEDLINE PubMed Immunology Abstracts Nucleic Acids Abstracts Oncogenes and Growth Factors Abstracts Virology and AIDS Abstracts AIDS and Cancer Research Abstracts ProQuest Health & Medical Complete (Alumni) MEDLINE - Academic PubMed Central (Full Participant titles) |
| DatabaseTitle | CrossRef MEDLINE Medline Complete MEDLINE with Full Text PubMed MEDLINE (Ovid) AIDS and Cancer Research Abstracts ProQuest Health & Medical Complete (Alumni) Immunology Abstracts Virology and AIDS Abstracts Oncogenes and Growth Factors Abstracts Nucleic Acids Abstracts MEDLINE - Academic |
| DatabaseTitleList | MEDLINE - Academic AIDS and Cancer Research Abstracts AIDS and Cancer Research Abstracts MEDLINE |
| Database_xml | – sequence: 1 dbid: NPM name: PubMed url: https://proxy.k.utb.cz/login?url=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed sourceTypes: Index Database – sequence: 2 dbid: EIF name: MEDLINE url: https://proxy.k.utb.cz/login?url=https://www.webofscience.com/wos/medline/basic-search sourceTypes: Index Database |
| DeliveryMethod | fulltext_linktorsrc |
| Discipline | Medicine |
| EISSN | 1527-3350 |
| EndPage | 576 |
| ExternalDocumentID | PMC3208905 3958121431 21274877 23883920 10_1002_hep_24060 HEP24060 |
| Genre | article Comparative Study Research Support, Non-U.S. Gov't Journal Article Research Support, N.I.H., Extramural |
| GrantInformation_xml | – fundername: This study was supported by the National Institutes of Health through a cooperative research agreement (DK U‐01‐58369), by the Northwestern Medical Foundation (Chicago, IL), and by the Southwestern Medical Foundation (Dallas, TX) This is manuscript 40 from the Acute Liver Failure Study Group. – fundername: NIDDK NIH HHS grantid: R01 DK058369 – fundername: NIDDK NIH HHS grantid: U01 DK058369 – fundername: NIDDK NIH HHS grantid: DK U-01-58369 |
| GroupedDBID | --- --K .3N .55 .GA .GJ .Y3 05W 0R~ 10A 186 1B1 1CY 1L6 1OB 1OC 1ZS 1~5 24P 31~ 33P 3O- 3SF 3WU 4.4 4G. 4ZD 50Y 50Z 51W 51X 52M 52N 52O 52P 52R 52S 52T 52U 52V 52W 52X 53G 5GY 5RE 5VS 7-5 702 7PT 8-0 8-1 8-3 8-4 8-5 8UM 930 A01 A03 AAEDT AAESR AAEVG AAHHS AALRI AANHP AAONW AAQFI AAQQT AAQXK AASGY AAXRX AAXUO AAZKR ABCQN ABCUV ABEML ABIJN ABLJU ABMAC ABOCM ABPVW ABWVN ABXGK ACAHQ ACBWZ ACCFJ ACCZN ACGFS ACLDA ACMXC ACPOU ACPRK ACRPL ACSCC ACXBN ACXQS ACYXJ ADBBV ADEOM ADIZJ ADKYN ADMGS ADMUD ADNMO ADOZA ADXAS ADZMN ADZOD AECAP AEEZP AEIMD AENEX AEQDE AEUQT AFBPY AFFNX AFGKR AFPWT AFUWQ AFZJQ AHMBA AIACR AIURR AIWBW AJAOE AJBDE ALAGY ALMA_UNASSIGNED_HOLDINGS ALUQN AMBMR AMYDB ASPBG ATUGU AVWKF AZBYB AZFZN AZVAB BAFTC BAWUL BDRZF BHBCM BMXJE BROTX BRXPI BY8 C45 CAG COF CS3 D-6 D-7 D-E D-F DCZOG DIK DPXWK DR2 DRFUL DRMAN DRSTM DU5 E3Z EBS EJD F00 F01 F04 F5P FD8 FDB FEDTE FGOYB FUBAC G-S G.N GNP GODZA H.X HBH HF~ HHY HHZ HVGLF HZ~ IHE IX1 J0M J5H JPC KBYEO KQQ LATKE LC2 LC3 LEEKS LH4 LITHE LOXES LP6 LP7 LUTES LW6 LYRES M41 M65 MJL MK4 MRFUL MRMAN MRSTM MSFUL MSMAN MSSTM MXFUL MXMAN MXSTM N04 N05 N4W N9A NF~ NNB NQ- O66 O9- OIG OK1 OVD P2P P2W P2X P2Z P4B P4D PALCI PQQKQ Q.N Q11 QB0 QRW R.K R2- RGB RIG RIWAO RJQFR ROL RPZ RWI RX1 RYL SEW SSZ SUPJJ TEORI UB1 V2E V9Y W2D W8V W99 WBKPD WH7 WHWMO WIB WIH WIJ WIK WIN WJL WOHZO WQJ WRC WUP WVDHM WXI X7M XG1 XV2 ZGI ZXP ZZTAW ~IA ~WT AAMMB AAYXX ABJNI ACZKN ADSXY AEFGJ AFNMH AGQPQ AGXDD AHQVU AIDQK AIDYY CITATION MEWTI WXSBR IQODW CGR CUY CVF ECM EIF NPM 7T5 7TM 7TO 7U9 H94 K9. 7X8 5PM |
| ID | FETCH-LOGICAL-c5710-5d16423dd07b17c5865e195868097160f6429c525ca7edcf0d853dc6728c31743 |
| IEDL.DBID | DR2 |
| ISSN | 0270-9139 1527-3350 |
| IngestDate | Thu Aug 21 13:38:08 EDT 2025 Fri Jul 11 03:45:31 EDT 2025 Fri Jul 11 07:28:30 EDT 2025 Sun Jul 13 04:18:15 EDT 2025 Mon Jul 21 05:56:26 EDT 2025 Mon Jul 21 09:17:38 EDT 2025 Wed Sep 10 05:01:09 EDT 2025 Thu Apr 24 23:07:25 EDT 2025 Wed Jan 22 17:00:43 EST 2025 |
| IsDoiOpenAccess | false |
| IsOpenAccess | true |
| IsPeerReviewed | true |
| IsScholarly | true |
| Issue | 2 |
| Keywords | Liver failure Paracetamol Analgesic Toxicity Acute Antimigrainous agent Gastroenterology Antipyretic Digestive diseases Hepatic disease |
| Language | English |
| License | http://doi.wiley.com/10.1002/tdm_license_1.1 CC BY 4.0 Copyright © 2010 American Association for the Study of Liver Diseases. |
| LinkModel | DirectLink |
| MergedId | FETCHMERGED-LOGICAL-c5710-5d16423dd07b17c5865e195868097160f6429c525ca7edcf0d853dc6728c31743 |
| Notes | Potential conflict of interest: Dr. Lee consults for Eli Lilly, Novartis, and Gilead. He receives grants from Bristol‐Myers Squibb, Vertex, SPRI, Siemens, and GlobeImmune. Dr. Larson is on the speakers' bureau of HCV Nova and SNPA Meeting Solutions. Dr. James is part owner of the Acetaminophen Toxicity Diagnostics. fax: 214‐645‐6111 ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 ObjectType-Article-2 ObjectType-Feature-1 The Acute Liver Failure Study Group from 1998-2006 was comprised of the following investigators and coordinators who worked tirelessly in support of this study: William M. Lee (PI), Anne M. Larson, Carla Pezzia, Kruti Joshi, Nahid Attar, Corron Sanders, University of Texas Southwestern Medical Center, Dallas, TX; Oren K. Fix, University of Washington, Seattle, WA; Timothy J. Davern, Kristine Partovi, University of California at San Francisco, San Francisco, CA; Lawrence U. Liu, Manuela Tiangco-Zuniga, Mt Sinai Medical Center, New York, NY; Timothy M. McCashland, Tamara Bernard, University of Nebraska, Omaha, NE; J. Eileen Hay, Cindy Groettum, Mayo Clinic, Rochester, MN; Natalie G. Murray, Sonnya Coultrup, Baylor University Medical Center, Dallas, TX; A. Obaid S. Shaikh, Linda Gooch, Diane Morton, University of Pittsburgh Medical Center, Pittsburgh, PA; Andres T. Blei, Daniel R. Ganger, Jeanne Gottstein, Northwestern University Medical School, Chicago, IL; Atif Zaman, Jonathan M. Schwartz, Kenneth Ingram, Willscott E. Naugler, Harlene Finn, Suni Wilson, Oregon Health & Science University, Portland, OR; Steven Han, Val Peacock, University of California at Los Angeles, Los Angeles, CA; Robert J. Fontana, Suzanne Welch, University of Michigan Medical Center, Ann Arbor, MI; Michael Schilsky, Noelle Sowers, Yale University School of Medicine, New Haven, CT; Brendan M. McGuire, Stacy Eddleman, Dorothy Faulk, University of Alabama, Birmingham, AL; Raymond T. Chung, Anna Rutherford, Michael Chen, Massachusetts General Hospital, Boston, MA; Robert S. Brown Jr., Jonathan Kim, Rudi Odeh-Ramadan, Columbia-Presbyterian Medical Center/Cornell-New York Hospital, New York, NY; Adrian Reuben, Stacey Minshall, Medical University of South Carolina, Charleston, SC; Santiago Munoz, Andres Riera, Stacey Carmody, Victoria Rudzik, Albert Einstein Medical Center, Philadelphia, PA; K. Rajender Reddy, Mical Campbell, Mary Hammond, Wojciech Blonksi, Kimberley Kime, University of Pennsylvania, Philadelphia, PA; Todd Stravitz, Melanie White, Virginia Commonwealth University, Richmond, VA; Lorenzo Rossaro, Laura Lester, Monica Ruiz, Yulia Suprun, University of California Davis, Sacramento, CA; Raj Satyanarayana, David Kramer, Dana Kontras, Mayo Clinic, Jacksonville, Jacksonville, FL; Tarek Hassenein, Fatma Barakat, Lita Petcharaporn, University of California at San Diego, San Diego, CA. |
| OpenAccessLink | https://www.ncbi.nlm.nih.gov/pmc/articles/3208905 |
| PMID | 21274877 |
| PQID | 1766822767 |
| PQPubID | 996352 |
| PageCount | 10 |
| ParticipantIDs | pubmedcentral_primary_oai_pubmedcentral_nih_gov_3208905 proquest_miscellaneous_848315164 proquest_miscellaneous_1776660219 proquest_journals_1766822767 pubmed_primary_21274877 pascalfrancis_primary_23883920 crossref_primary_10_1002_hep_24060 crossref_citationtrail_10_1002_hep_24060 wiley_primary_10_1002_hep_24060_HEP24060 |
| PublicationCentury | 2000 |
| PublicationDate | February 2011 |
| PublicationDateYYYYMMDD | 2011-02-01 |
| PublicationDate_xml | – month: 02 year: 2011 text: February 2011 |
| PublicationDecade | 2010 |
| PublicationPlace | Hoboken |
| PublicationPlace_xml | – name: Hoboken – name: Hoboken, NJ – name: United States |
| PublicationTitle | Hepatology (Baltimore, Md.) |
| PublicationTitleAlternate | Hepatology |
| PublicationYear | 2011 |
| Publisher | Wiley Subscription Services, Inc., A Wiley Company Wiley Wolters Kluwer Health, Inc |
| Publisher_xml | – name: Wiley Subscription Services, Inc., A Wiley Company – name: Wiley – name: Wolters Kluwer Health, Inc |
| References | 1989; 248 1989; 97 1990; 104 2006; 51 2002; 30 2010 2006; 130 2008; 14 2005; 42 2002; 137 1975; 55 2001; 33 2008; 84 2006; 118 2007; 35 2007; 46 2003; 188 2009; 37 2009; 137 1970; 3 James (10.1002/hep.24060-BIB11|cit11) 2008; 84 Teo (10.1002/hep.24060-BIB19|cit19) 2001; 33 Pumford (10.1002/hep.24060-BIB8|cit8) 1989; 248 Pumford (10.1002/hep.24060-BIB9|cit9) 1990; 104 James (10.1002/hep.24060-BIB18|cit18) 2007; 46 Rumack (10.1002/hep.24060-BIB5|cit5) 1975; 55 Muldrew (10.1002/hep.24060-BIB7|cit7) 2002; 30 10.1002/hep.24060-BIB16|cit16 Larson (10.1002/hep.24060-BIB2|cit2) 2005; 42 Umemura (10.1002/hep.24060-BIB20|cit20) 2003; 188 James (10.1002/hep.24060-BIB10|cit10) 2006; 118 Stravitz (10.1002/hep.24060-BIB4|cit4) 2007; 35 O'Grady (10.1002/hep.24060-BIB14|cit14) 1989; 97 Trey (10.1002/hep.24060-BIB1|cit1) 1970; 3 Kamath (10.1002/hep.24060-BIB13|cit13) 2001; 33 James (10.1002/hep.24060-BIB12|cit12) 2009; 37 Ostapowicz (10.1002/hep.24060-BIB3|cit3) 2002; 137 10.1002/hep.24060-BIB15|cit15 Davern (10.1002/hep.24060-BIB6|cit6) 2006; 130 Lee (10.1002/hep.24060-BIB17|cit17) 2009; 137 Lee (10.1002/hep.24060-BIB21|cit21) 2006; 51 Levitsky (10.1002/hep.24060-BIB22|cit22) 2008; 14 21360569 - Hepatology. 2011 Aug;54(2):746-7. doi: 10.1002/hep.24251. |
| References_xml | – volume: 55 start-page: 871 year: 1975 end-page: 876 article-title: Acetaminophen poisoning and toxicity publication-title: Pediatrics – volume: 137 start-page: 947 year: 2002 end-page: 954 article-title: Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States publication-title: Ann Intern Med – volume: 137 start-page: 856 year: 2009 end-page: 864 article-title: Intravenous N‐acetylcysteine improves transplant‐free survival in early stage non‐acetaminophen acute liver failure publication-title: Gastroenterology – volume: 37 start-page: 1779 year: 2009 end-page: 1784 article-title: Pharmacokinetics of acetaminophen protein adducts in adults with acetaminophen overdose and acute liver failure publication-title: Drug Metab Dispos – volume: 33 start-page: 972 year: 2001 end-page: 976 article-title: Hepatitis B infection in patients with acute liver failure in the United States publication-title: HEPATOLOGY – volume: 42 start-page: 1364 year: 2005 end-page: 1372 article-title: Acetaminophen‐induced acute liver failure: results of a United States multicenter, prospective study publication-title: HEPATOLOGY – volume: 118 start-page: e676 year: 2006 end-page: e681 article-title: Detection of acetaminophen protein adducts in children with acute liver failure of indeterminate cause publication-title: Pediatrics – volume: 33 start-page: 464 year: 2001 end-page: 470 article-title: A model to predict survival in patients with end‐stage liver disease publication-title: HEPATOLOGY – volume: 14 start-page: 1498 year: 2008 end-page: 1504 article-title: Detection and diagnosis of herpes virus infection in adults with acute liver failure publication-title: Liver Transpl – volume: 84 start-page: 684 year: 2008 end-page: 690 article-title: Acetaminophen‐associated hepatic injury: evaluation of acetaminophen protein adducts in children and adolescents with acetaminophen overdose publication-title: Clin Pharmacol Ther – volume: 46 start-page: 812A issue: Suppl 1 year: 2007 article-title: Detection of acetaminophen protein adducts in serum during therapeutic exposure to acetaminophen in healthy volunteers [Abstract] publication-title: HEPATOLOGY – volume: 104 start-page: 521 year: 1990 end-page: 532 article-title: Immunoblot analysis of protein containing 3‐(cystein‐S‐yl) acetaminophen adducts in serum and subcellular liver fractions from acetaminophen‐treated mice publication-title: Toxicol Appl Pharmacol – volume: 51 start-page: 1712 year: 2006 end-page: 1715 article-title: No evidence for parvovirus B19 or hepatitis E virus as a cause of acute liver failure publication-title: Dig Dis Sci – volume: 35 start-page: 2498 year: 2007 end-page: 2508 article-title: Intensive care of patients with acute liver failure: recommendations of the U.S. Acute Liver Failure Study Group publication-title: Crit Care Med – volume: 130 start-page: 687 year: 2006 end-page: 694 article-title: Measurement of serum acetaminophen‐protein adducts in patients with acute liver failure publication-title: Gastroenterology – volume: 97 start-page: 439 year: 1989 end-page: 445 article-title: Early indicators of prognosis in fulminant hepatic failure publication-title: Gastroenterology – volume: 30 start-page: 446 year: 2002 end-page: 451 article-title: Determination of acetaminophen‐protein adducts in mouse liver and serum and human serum after hepatotoxic doses of acetaminophen using high‐performance liquid chromatography with electrochemical detection publication-title: Drug Metab Dispos – volume: 248 start-page: 190 year: 1989 end-page: 196 article-title: Immunochemical quantitation of 3‐(cystein‐S‐yl) acetaminophen adducts in serum and liver proteins of acetaminophen‐treated mice publication-title: J Pharmacol Exp Ther – volume: 3 start-page: 282 year: 1970 end-page: 298 article-title: The management of fulminant hepatic failure publication-title: Prog Liver Dis – year: 2010 – volume: 188 start-page: 1545 year: 2003 end-page: 1552 article-title: Investigation of SEN virus infection in patients with cryptogenic acute liver failure, hepatitis‐associated aplastic anemia, or acute and chronic non‐A‐E hepatitis publication-title: J Infect Dis – ident: 10.1002/hep.24060-BIB15|cit15 – volume: 137 start-page: 947 year: 2002 ident: 10.1002/hep.24060-BIB3|cit3 article-title: Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States publication-title: Ann Intern Med doi: 10.7326/0003-4819-137-12-200212170-00007 – volume: 130 start-page: 687 year: 2006 ident: 10.1002/hep.24060-BIB6|cit6 article-title: Measurement of serum acetaminophen-protein adducts in patients with acute liver failure publication-title: Gastroenterology doi: 10.1053/j.gastro.2006.01.033 – volume: 35 start-page: 2498 year: 2007 ident: 10.1002/hep.24060-BIB4|cit4 article-title: Intensive care of patients with acute liver failure: recommendations of the U.S. Acute Liver Failure Study Group publication-title: Crit Care Med doi: 10.1097/01.CCM.0000287592.94554.5F – volume: 55 start-page: 871 year: 1975 ident: 10.1002/hep.24060-BIB5|cit5 article-title: Acetaminophen poisoning and toxicity publication-title: Pediatrics doi: 10.1542/peds.55.6.871 – volume: 97 start-page: 439 year: 1989 ident: 10.1002/hep.24060-BIB14|cit14 article-title: Early indicators of prognosis in fulminant hepatic failure publication-title: Gastroenterology doi: 10.1016/0016-5085(89)90081-4 – volume: 51 start-page: 1712 year: 2006 ident: 10.1002/hep.24060-BIB21|cit21 article-title: No evidence for parvovirus B19 or hepatitis E virus as a cause of acute liver failure publication-title: Dig Dis Sci doi: 10.1007/s10620-005-9061-5 – volume: 118 start-page: e676 year: 2006 ident: 10.1002/hep.24060-BIB10|cit10 article-title: Detection of acetaminophen protein adducts in children with acute liver failure of indeterminate cause publication-title: Pediatrics doi: 10.1542/peds.2006-0069 – volume: 37 start-page: 1779 year: 2009 ident: 10.1002/hep.24060-BIB12|cit12 article-title: Pharmacokinetics of acetaminophen protein adducts in adults with acetaminophen overdose and acute liver failure publication-title: Drug Metab Dispos doi: 10.1124/dmd.108.026195 – volume: 248 start-page: 190 year: 1989 ident: 10.1002/hep.24060-BIB8|cit8 article-title: Immunochemical quantitation of 3-(cystein-S-yl) acetaminophen adducts in serum and liver proteins of acetaminophen-treated mice publication-title: J Pharmacol Exp Ther doi: 10.1016/S0022-3565(25)23630-8 – volume: 104 start-page: 521 year: 1990 ident: 10.1002/hep.24060-BIB9|cit9 article-title: Immunoblot analysis of protein containing 3-(cystein-S-yl) acetaminophen adducts in serum and subcellular liver fractions from acetaminophen-treated mice publication-title: Toxicol Appl Pharmacol doi: 10.1016/0041-008X(90)90174-S – volume: 14 start-page: 1498 year: 2008 ident: 10.1002/hep.24060-BIB22|cit22 article-title: Detection and diagnosis of herpes virus infection in adults with acute liver failure publication-title: Liver Transpl doi: 10.1002/lt.21567 – volume: 137 start-page: 856 year: 2009 ident: 10.1002/hep.24060-BIB17|cit17 article-title: Intravenous N-acetylcysteine improves transplant-free survival in early stage non-acetaminophen acute liver failure publication-title: Gastroenterology doi: 10.1053/j.gastro.2009.06.006 – volume: 3 start-page: 282 year: 1970 ident: 10.1002/hep.24060-BIB1|cit1 article-title: The management of fulminant hepatic failure publication-title: Prog Liver Dis – volume: 33 start-page: 972 year: 2001 ident: 10.1002/hep.24060-BIB19|cit19 article-title: Hepatitis B infection in patients with acute liver failure in the United States publication-title: HEPATOLOGY doi: 10.1053/jhep.2001.23065 – volume: 188 start-page: 1545 year: 2003 ident: 10.1002/hep.24060-BIB20|cit20 article-title: Investigation of SEN virus infection in patients with cryptogenic acute liver failure, hepatitis-associated aplastic anemia, or acute and chronic non-A-E hepatitis publication-title: J Infect Dis doi: 10.1086/379216 – volume: 46 start-page: 812A issue: Suppl 1 year: 2007 ident: 10.1002/hep.24060-BIB18|cit18 article-title: Detection of acetaminophen protein adducts in serum during therapeutic exposure to acetaminophen in healthy volunteers [Abstract] publication-title: HEPATOLOGY – volume: 30 start-page: 446 year: 2002 ident: 10.1002/hep.24060-BIB7|cit7 article-title: Determination of acetaminophen-protein adducts in mouse liver and serum and human serum after hepatotoxic doses of acetaminophen using high-performance liquid chromatography with electrochemical detection publication-title: Drug Metab Dispos doi: 10.1124/dmd.30.4.446 – ident: 10.1002/hep.24060-BIB16|cit16 – volume: 42 start-page: 1364 year: 2005 ident: 10.1002/hep.24060-BIB2|cit2 article-title: Acetaminophen-induced acute liver failure: results of a United States multicenter, prospective study publication-title: HEPATOLOGY doi: 10.1002/hep.20948 – volume: 33 start-page: 464 year: 2001 ident: 10.1002/hep.24060-BIB13|cit13 article-title: A model to predict survival in patients with end-stage liver disease publication-title: HEPATOLOGY doi: 10.1053/jhep.2001.22172 – volume: 84 start-page: 684 year: 2008 ident: 10.1002/hep.24060-BIB11|cit11 article-title: Acetaminophen-associated hepatic injury: evaluation of acetaminophen protein adducts in children and adolescents with acetaminophen overdose publication-title: Clin Pharmacol Ther doi: 10.1038/clpt.2008.190 – reference: 21360569 - Hepatology. 2011 Aug;54(2):746-7. doi: 10.1002/hep.24251. |
| SSID | ssj0009428 |
| Score | 2.3947177 |
| Snippet | Despite extensive investigations, the cause of liver injury in 14% of patients with acute liver failure remains unknown (indeterminate). In a pilot study using... |
| SourceID | pubmedcentral proquest pubmed pascalfrancis crossref wiley |
| SourceType | Open Access Repository Aggregation Database Index Database Enrichment Source Publisher |
| StartPage | 567 |
| SubjectTerms | Acetaminophen - adverse effects Acetylcysteine - therapeutic use Adult Analgesics Analgesics, Non-Narcotic - adverse effects Bilirubin - blood Biological and medical sciences Chemical and Drug Induced Liver Injury - blood Chemical and Drug Induced Liver Injury - diagnosis Chemical and Drug Induced Liver Injury - drug therapy Drug Overdose Female Free Radical Scavengers - therapeutic use Gastroenterology. Liver. Pancreas. Abdomen Hepatology Humans Liver Liver Failure, Acute - blood Liver Failure, Acute - chemically induced Liver Failure, Acute - diagnosis Liver. Biliary tract. Portal circulation. Exocrine pancreas Male Medical sciences Middle Aged Other diseases. Semiology Prognosis Retrospective Studies Severity of Illness Index Survival Rate Toxicity Transaminases - blood |
| Title | Unrecognized acetaminophen toxicity as a cause of indeterminate acute liver failure |
| URI | https://onlinelibrary.wiley.com/doi/abs/10.1002%2Fhep.24060 https://www.ncbi.nlm.nih.gov/pubmed/21274877 https://www.proquest.com/docview/1766822767 https://www.proquest.com/docview/1776660219 https://www.proquest.com/docview/848315164 https://pubmed.ncbi.nlm.nih.gov/PMC3208905 |
| Volume | 53 |
| hasFullText | 1 |
| inHoldings | 1 |
| isFullTextHit | |
| isPrint | |
| link | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnV1ba9RAFB5KH0QQ75et7TKKD75km80kc8EnqS2rUhF1oQ9CmMyFLtbs0iRg--t7zuSyrrYgviwL84UwJ-ec-U7m5BtCXgFF8JDy0ohbb6NUYh70XkdKMGW8dS4R-HHy8Sc-m6cfTrKTLfKm_xam1YcYXrhhZIR8jQGui2p_LRp66lYTXI6wXp8yjrr5776spaNUGs5Vhaorxt1l1asKxcn-cOXGWnRnpSswi2_Ps7iOcP7dN_k7nw0L0tE98r2fStuH8mPS1MXEXP6h8vifc71P7nZElb5tPesB2XLlQ3LruNuKf0S-zsuu-ejSWaqNq_XPRYkqBSWtl78AVV9QXVFNjW4qR5eeojJj13xTO7ikgd8z7AuhXi-wPf4xmR8dfjuYRd0JDZHJgJpEmYVqK2HWxqKYCpNJnjlUr-EySFPFHkaVyZLMaAFm87EFdmANF4k0DGuhJ2S7XJbuGaGploxZSCmukGkxtZpx5bQ3kH6dVy4dkdf9s8pNJ1-Op2ic5a3wcpKDkfJgpBF5OUBXrWbHdaDxxgMfkMBhkDQCYLf3gLyL6ypHOU2gVIKLEXkxDENE4jaLLt2yQQyAOHAnNSL0BoxMJQOuxWFaT1ufWt9_mgioIuEGYsPbBgAKgm-OlIvTIAzOkliqOANTBWe6efL57PBz-LPz79Dn5Hb7Ph1beXbJdn3euD0gZHUxhsh7_3Ec4u8KFV4zyg |
| linkProvider | Wiley-Blackwell |
| linkToHtml | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnV1ba9RAFD6UCiqI98vaWkfxwZdss7nMZMCXUlpW7RbRLvRFwmQudLFmFzcB7a_vOZPLutqC-BIC84UwJ-ec-Wbm5BuAN0gRHKa8JODGmSDJKA86pwIpYqmdsTYS9HPy5JiPp8mH0_R0A951_8I0-hD9ghtFhs_XFOC0IL27Ug09s4shjUc4Yb_h9-eIEn1eiUfJxJ-sivOukPaXZacrFEa7_aNro9GdhVqiYVxzosVVlPPvysnfGa0fkg7vwdeuM00lyrdhXRVDffGHzuP_9vY-3G25KttrnOsBbNjyIdyctLvxj-DLtGzrjy6sYUrbSn2flSRUULJq_hNR1S-mlkwxreqlZXPHSJyxrb-pLD5S4_WcSkOYUzOqkH8M08ODk_1x0B7SEOgU2UmQGpxwRbExoShGQqcZTy0J2PDMq1OFDlulTqNUK4F2c6FBgmA0F1GmY5oOPYHNcl7aZ8ASlcWxwaxiiywpRkbFXFrlNGZg66RNBvC2-1i5bhXM6SCN87zRXo5yNFLujTSA1z100ch2XAXaWfviPRJpDPFGBGx3LpC3ob3MSVETWZXgYgCv-mYMStppUaWd14RBEEf6JAfArsFkSRYj3eLYraeNU63eP4oETiTxBWLN3XoAaYKvt5SzM68NHkdhJsMUTeW96frO5-ODT_7m-b9DX8Kt8cnkKD96f_xxC243y-tU2bMNm9WP2r5AflYVOz4MLwHvDDbv |
| linkToPdf | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnV1ba9RAFB5KhSKI9e62tY7igy_ZZpPJXPBJtMt6aSnqQh-EMJkLXazZxU3A9td7zuSyrrYgviwL84UwJ-ec-U7m5BtCXgBF8JDyWMSttxGTmAe915ESqTLeOpcI_Dj56JhPpuz9aXa6QV5138I0-hD9CzeMjJCvMcAX1h-sREPP3GKIyxHU6zcYh2USGdGnlXaUYuFgVSi7YtxeVp2sUJwc9JeuLUa3FnoJdvHNgRZXMc6_Gyd_J7RhRRpvk6_dXJpGlG_DuiqG5vIPmcf_nOwdcrtlqvR141p3yYYr75Gto3Yv_j75PC3b7qNLZ6k2rtLfZyXKFJS0mv8EVHVB9ZJqanS9dHTuKUoztt03lYNLavg9x8YQ6vUM--MfkOn48MubSdQe0RCZDLhJlFkot5LU2lgUI2EyyTOH8jVcBm2q2MOoMlmSGS3AbD62QA-s4SKRJsVi6CHZLOele0wo0zJNLeQUV0hWjKxOuXLaG8i_zivHBuRl96xy0-qX4zEa53mjvJzkYKQ8GGlAnvfQRSPacRVof-2B90ggMcgaAbDXeUDeBvYyRz1N4FSCiwF51g9DSOI-iy7dvEYMgMAjR2pA6DUYyWQKZIvDtB41PrW6_ygRUEbCDcSat_UAVARfHylnZ0EZPE1iqeIMTBWc6frJ55PDk_Bn59-hT8nWydtx_vHd8YddcrN5t45tPXtks_pRuydAzqpiPwThLyidNZ4 |
| openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Unrecognized+acetaminophen+toxicity+as+a+cause+of+indeterminate+acute+liver+failure&rft.jtitle=Hepatology+%28Baltimore%2C+Md.%29&rft.au=Khandelwal%2C+Niraj&rft.au=James%2C+Laura+P&rft.au=Sanders%2C+Corron&rft.au=Larson%2C+Anne+M&rft.date=2011-02-01&rft.pub=Wolters+Kluwer+Health%2C+Inc&rft.issn=0270-9139&rft.eissn=1527-3350&rft.volume=53&rft.issue=2&rft.spage=567&rft_id=info:doi/10.1002%2Fhep.24060&rft.externalDBID=NO_FULL_TEXT&rft.externalDocID=3958121431 |
| thumbnail_l | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=0270-9139&client=summon |
| thumbnail_m | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=0270-9139&client=summon |
| thumbnail_s | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=0270-9139&client=summon |