Suspected hepatotoxicity effect of amiodarone (amiodarone and liver)

Abstract

Introduction: Acute hepatotoxicity is a rare but potentially fatal complication of amiodarone use. We report a case of liver injury after intravenous amiodarone administration in a patient with atrial fibrillation after heart surgery. Case report: A 62-year-old man with a history of dissection of the ascending aortic aneurysm presented for emergency ascending aorta surgery. Patient underwent a routine aortic ascending surgery. On the 3rd postoperative day, the patient developed rapid atrial fibrillation, which was treated with intravenous amiodarone. Because of hypotension, 12 h later, phenylephrine and norepinephrine were included. The patient's lactate had increased to 3.8 mmol/ L, the international normalized ratio increased to 3.12, alanine aminotransferase rose to 4401 IU/L, aspartate aminotransferase rose to 7355 IU/L, lactate dehydrogenase rose to 30043 IJ/L and creatinine increased from 96 to 190 μg/l. Amiodarone was discontinued. Urine output decreased. On the 5th postoperative day, rhythm converted to the sinus rhythm. Liver parameters significantly improved and returned to normal. On the 13th postoperative day, patient was discharged to a rehabilitation facility. Conclusion: Amiodarone is used to treat life-threatening arrhythmias in the setting of acutely decompensated heart failure. In the presence of hepatic congestion, the intravenous preparation of amiodarone may cause acute liver injury and liver function should be monitored closely in critically ill patients.