Lab Case 111 – Interpretation

44 year old man presents with severe Paracetamol toxicityDescribe and Interpret:

Deranged LFTs with normal Paracetamol level suggest established toxicity in the absence of another cause – (2-3 days)

Severe elevation in ALT – hepatocellular necrosis

Elevated INR, low Albumin – Impaired hepatic synthetic function

Evidence of end organ damage – abnormal renal function and liver function

Normal electrolytes

Clinical Phases of Paracetamol Toxicity:

Phase 1

(<24 hours)


Nausea, Vomiting

Phase 2

(1-3 days)

RUQ tenderness

ALT/AST rise rapidly, peak at 48-72 hours, may reach 15000-20000

Hepatoxicity is ALT > 1000

INR/PT are most abnormal within hours of ALT/ AST peak


Impaired renal function

Phase 3

3-4 days

Fulminant hepatic failure – coagulopathy, jaundice, encephalopathy, multi organ failure, progressing to death

In patients who die:

Lactic acidosis, elevated lactate despite resuscitation

Renal failure (Creat > 300)

Worsening coagulopathy (PT > 100 sec) and encephalopathy

Phase 4

4 days-3 weeks

Recovery phase

Hepatic structure and function return to normal