Acetaminophen Hepatotoxicity Associated With Alcoholic Pancreatitis

To the Editor.  —We wish to report the clinical association of acetaminophen hepatotoxicity and alcoholic pancreatitis in three patients who were recently admitted to our institution after having ingested large quantities of acetaminophen in an attempt to self-treat pain associated with alcoholic pancreatitis (Table).Acetaminophen is hepatotoxic after acute ingestion of 10 to 15 g.¹ Five grams to 10 g may be hepatotoxic with long-term alcohol abuse^2-4 and malnutrition.⁵ In our patients, 7 to 11 g/day of acetaminophen was taken and a laboratory test pattern typical of acetaminophen hepatotoxicity developed. None of these patients had clinical evidence for another cause of such dramatically elevated liver test results (such as viral or ischemic hepatitis). Patients with alcoholic pancreatitis may be more prone to acetaminophen hepatotoxicity because of their taking supratherapeutic amounts of acetaminophen for pain and using alcohol for long periods, which induces the hepatic—mixed function oxidases that