Which hepatic zone is initially affected first during an acute acetaminophen poisoning?
Hepatic zone III is where toxicity is noted first due to the higher concentration of CYP enzymes (more oxidative metabolism) compared to the other two zones. Necrosis of these hepatocytes is responsible for the elevation in transaminases seen in the setting of acetaminophen poisoning.
McGill MR, Sharpe MR, Williams CD, Taha M, Curry SC, Jaeschke H. The mechanism underlying acetaminophen-induced hepatotoxicity in humans and mice involves mitochondrial damage and nuclear DNA fragmentation. J Clin Invest. 2012;122(4):1574-1583. doi:10.1172/JCI59755
Contributed by: Austin Miller, MD Candidate
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