could rifampin treatment cause liver failure down the road?

pennyaline · Feb 19, 2010

I am a student and I had a patient a few weeks ago, we are studing respiratory now in Med Surg and of course one of the side effects of Rifampin are Hepatitis....well my pt had liver failure and ascites and it turned out she had previously been treated for TB with rifampin, I had to wonder if there was a connection? Do you think this could be? or I am grasping at straws? no one seemed to know what had caused her problem. She denied use of alcohol.
angels mommy:idea:

Unfortunately, patients are often not honest and forthcoming about their histories so the cause of the liver failure will probably remain speculative forever. It's possible that Rifampin was involved, and it's possible that there is a constellation of causes that the patient will never admit to. At this point, it is less important to know what caused her liver failure and ascites and more important to treat the conditions and make her more comfortable.

Murse901, MSN, RN · Feb 19, 2010

TB meds such as Rifampin and Isoniazid are associated with the potential for liver damage. Our facility's medical director goes so far as to restrict any and all NSAID's for any patient on TB meds just to reduce the possibility of damage.

Very possible that the patient could have been on Rifampin, popping Tylenol, and drinking, all while their liver was screaming for help.

anangelsmommy, ADN, BSN, RN · Feb 20, 2010

This is the second pt in a week that has had liver failure and denied alcohol use - though in this ones chart - the doc had written in used alchol "to abuse" so apparently there was a hx of alchol abuse even if he no longer used. and even the family was in on the denial, all discussing how apparent use of tylenol was to blame for the liver failure, which I am sure along with the percoset, alcohol and tylenol, sure yes this may have caused it but probably not just tylenol alone! It continues to amaze me how not only are the patients in complete and utter denial but so are the families...I guess this is pretty common? and not that it needs to be a blame game but you need to identify it to be sure there isnt further abuse and further damage, if that is the case.

angels mommy...

anangelsmommy, ADN, BSN, RN · Feb 20, 2010

good point...she said that she would only have a little sip of something here and there on a holiday.... and could never give cause for liver failure but we had to do paracentisis twice in one week for the ascites and took off 12 liters each time - it was amazing and to be honest we could probably just keep going if we werent worried about shock.

questionsforall · Feb 20, 2010

I worked in an ICU with patients in liver failure. I will tell you that I have seen patient's awaiting transplant with the a large variety of causes for their liver failure. Most of them are not alcohol related. They will not even transplant someone who has been drinking alcohol upon admission (they need to be sober at least 6 months of un-hospitalized time). The causes I have seen are as follows: autoimmune diseases, liver cancer, statins, tylenol overdose, herbal medications, Wilson's disease. There are so many causes and combinations of causes that anything is possible.

anangelsmommy, ADN, BSN, RN · Feb 20, 2010

Questionsforall - do you find that they KNOW the reason for the liver failure? do they test for it? if they can? or is it simply history? I haven't seen in these pts any reasons other than speculation for the failure.

angels mommy

questionsforall · Feb 24, 2010

Sometimes I see them testing for these autoimmune disorders . Tylenol overdose is the know reason because the patient usually admits to the overdose. In the case of the statins the patient had normal liver function prior to taking the statins and elevated liver function levels after the statins. In fact, the patient was bumped to the top of the liver transplant list because he/she was so sick and because it was a statin that caused it. Other times I have seen where they did speculate and find multiple things that could have resulted in liver failure (ex. herbal remedies and tylenol use). I will say though that about half the patients I see with liver failure have no history of alcohol abuse.