Therapeutic Plasma Exchange as a Life-Saving Intervention in Severe Acetaminophen Toxicity: A Case Report

Dr. Kingsley S, Dr. Pratiksha Rane

Abstract: Background: Paracetamol (acetaminophen) overdose is one of the most common causes of acute liver failure worldwide. Due to its over-the-counter availability and widespread use as an analgesic and antipyretic, it is frequently implicated in intentional self-harm. The standard treatment is N-acetylcysteine (NAC); however, patients who progress to acute liver failure with worsening coagulopathy and hepatic encephalopathy may require advanced supportive therapies and liver transplantation. Therapeutic plasma exchange (TPE) has emerged as a potential adjunct in such severe cases. Case Presentation: An 18-year-old female presented following intentional ingestion of approximately 20 g of paracetamol. Despite early initiation of N-Acetyl Cysteine (NAC) therapy, she developed acute liver injury characterized by markedly elevated transaminases, progressive coagulopathy and drowsiness. She was admitted to the intensive care unit and managed with standard supportive care along with six sessions of therapeutic plasma exchange. Following TPE, significant improvement was observed in liver function tests, coagulation parameters, and neurological status, leading to clinical recovery without the need for liver transplantation. Conclusion: Therapeutic plasma exchange may serve as an effective adjunctive treatment in severe paracetamol-induced acute liver failure. It can improve biochemical and clinical outcomes and may help bridge patients to recovery, particularly in settings where liver transplantation is not readily available.

Keywords: Paracetamol overdose, Acute liver failure, Therapeutic plasma exchange, N-acetylcysteine, Liver transplantation

How to Cite?: Dr. Kingsley S, Dr. Pratiksha Rane, "Therapeutic Plasma Exchange as a Life-Saving Intervention in Severe Acetaminophen Toxicity: A Case Report", Volume 15 Issue 8, August 2026, International Journal of Science and Research (IJSR), Pages: 2199-2201, https://www.ijsr.net/getabstract.php?paperid=SR26831161523, DOI: https://dx.doi.org/10.21275/SR26831161523

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