DrVirgo
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do you know the answer?
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| robin082006
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I go with B
But E may be correct too
other choices are not suitable
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| DrVirgo
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I thought E as well.
? Proceed with transplant? The other choices not to proceed sound like distractors.
any other people want to go for it?
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| robin082006
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SInce this is acute hepatitis due to drug overdose so this may recover completely, that makes me go with B
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The Key to Succeed is Patience.
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| elitoki
Forum Guru
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I think is E.
Acetaminophen toxicity has 4 phases.
In phase 4, that occur after 4 days until +-3 wks, patients usually recover from drug overdose. But in this case pts has 6 days of symptoms and apparently is getting worse, just because from hepatic failure-> encephalopathy -> now, comatose!!!
In my opinion if we have donor and pt is getting worse we should go with transplant and no waiting one week more to see if pt may recover.
My answer will be E. 
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| DrVirgo
Forum Hero
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Ok, here is what I think:
Acetaminophen first causes N/V because gastritis from irritation of the GI within the first 12-24 hours.
then 24-72 hours--- there is an asymptomatic period- where the toxic metabolites are being formed. there is an increase in transaminases, bili, etc. which indicate HEPATIC NECROSIS! ---> This is NOT REVERSIBLE!
48-72 hours -- signs of liver damage, Nausea again, Jaundice, abdom pain, adn signs of hepatic encephalopathy, renal failure and death...
Transplant has to be done. I'll stick with my answer -E
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Our greatest glory is not in never falling, but in rising every time we fall.
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| haduytu7
Forum Newbie
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When I did NBME I picked E, but after read indication and contra indication for liver transplantation, now I think C is the correct answer.
One of the contraindications is: Uncontrolled psychiatric disorder.
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| liliaeliz
Forum Elite
Topics: 30
Posts: 284
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haduytu 7 can you say me where you read that ? thanks
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