Adolescent With Acute Liver Failure in the Setting of Ethanol, Cocaine, and Ecstasy Ingestion Treated With a Molecular Adsorbent Recirculating System

Jacquelin Peck,Nina Replete,Francisco Flores,Michael Wilsey,Stephanie Melquist

doi:10.7759/cureus.9699

Abstract

Recreational polypharmacy intoxication is a popular trend, particularly among adolescents and young adults. Acute liver failure is an uncommon complication of drug intoxication and has been described separately among patients intoxicated with ethanol, cocaine, and 3,4-methylenedioxy-methamphetamine (MDMA, ecstasy). Many patients with acute liver failure will die without liver transplant, and management of drug-induced acute liver failure is complicated by the fact that polysubstance abuse may be a contraindication for liver transplant, even among young patients.Here we report a case of acute liver failure in an adolescent male secondary to recreational intoxication with ethanol, cocaine, and ecstasy. This patient was not a candidate for liver transplantation. We describe successful treatment using a molecular adsorbent recirculating system (MARS®) or “liver dialysis” and review the literature pertaining to management options for this type of patient.

Highlights

Combination drug use is a well-established and growing trend among adolescents and young adults
Acute liver failure is an uncommon complication of drug intoxication and has been described separately among patients intoxicated with ethanol, cocaine, and 3,4-methylenedioxy-methamphetamine (MDMA, ecstasy)
We describe successful treatment using a molecular adsorbent recirculating system (MARS®) or “liver dialysis” and review the literature pertaining to management options for this type of patient

Summary

Introduction

Combination drug use is a well-established and growing trend among adolescents and young adults. We report a case of ALF in an adolescent male secondary to simultaneous recreational use of ethanol, cocaine and MDMA This patient’s history of polydrug abuse precluded liver transplantation, and treatment included the use of a Molecular Adsorbent Recirculating System (MARS® therapy) or "liver dialysis.". He received immediate renal replacement therapy, which did not significantly improve his clinical picture. The patient was transferred to a liver transplant center on day 3 due to unknown trajectory of the hepatic failure At that facility, he was determined not to be a candidate for liver transplantation because of his history of polysubstance abuse and he continued to receive MARS therapy and renal dialysis as needed. Hemodialysis was discontinued as an outpatient after he had full recovery of his renal function

Discussion

Conclusions

Findings

Disclosures