Hepatic dysfunction accompanying acute cocaine intoxication

Marcelo O. Silva, David Roth, K. Rajender Reddy, John A. Fernandez, Jorge Albores-Saavedra, Eugene R. Schiff

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Abstract

We identified 39 patients with acute cocaine intoxication and rhabdomyolysis over an 8-year period. Twenty-three of the patients (59%) demonstrated biochemical evidence for hepatic dysfunction. Sixteen of these patients had severe liver injury as defined by an alanine aminotransferase (ALT) of > 400 U/l (group A). Seven had an ALT between 36-399 U/l (group B) and 16 showed no evidence of liver injury (group C). In contrast to those with normal ALT, the clinical course of the group A patients was more often accompanied by profound hypotension (44 vs. 0%, p < 0.025), disseminated intravascular coagulation (50 vs. 0%, p < 0.005), hyperpyrexia (75 vs. 25%, p < 0.025) and acute renal failure (81 vs. 0%, p < 0.001). Seven of the group A patients expired (44%). Histologic examination of liver tissue obtained from post-mortem samples demonstrated extensive centrilobular and midzonal necrosis in three cases and panlobular necrosis in two others. A mild lymphocytic infiltrate with bile duct proliferation was present in each specimen. We conclude that cocaine intoxication can be accompanied by liver dysfunction which is most likely multifactorial; the presence of severe dysfunction identifies a patient with potentially significant morbidity and mortality.

Original languageEnglish (US)
Pages (from-to)312-315
Number of pages4
JournalJournal of Hepatology
Volume12
Issue number3
DOIs
StatePublished - May 1991

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ASJC Scopus subject areas

  • Hepatology

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