S5819 Missed in Translation: Preventable Hepatotoxicity From Amiodarone Overdose in a LEP Patient

Introduction: Language barriers in healthcare pose a well-documented threat to patient safety, particularly among individuals with limited English proficiency (LEP). These barriers contribute to miscommunication, treatment nonadherence, and a higher incidence of medication errors. This case highlights a serious, preventable instance of drug-induced liver injury secondary to chronic amiodarone overdose in an LEP patient. Case Description/Methods: A 44-year-old man with a history of ventricular arrhythmias and AICD placement presented with fatigue, abdominal discomfort, nausea, and fever of one-month duration. The patient, whose primary language is Hakha Chin, misunderstood his amiodarone prescription and ingested 1,600 mg/day—quadruple the intended dose of 400 mg/day—due to lack of interpreter support. Initial laboratory tests revealed marked transaminitis (alanine aminotransferase 1140 U/L, aspartate aminotransferase 715 U/L) with preserved bilirubin, international normalized ratio, and renal function. Imaging (CT abdomen, liver Doppler, MRCP) excluded biliary obstruction or structural liver disease. Influenza A (2009 H1) was detected but without respiratory symptoms. The patient was managed supportively, amiodarone was discontinued, and liver enzymes gradually normalized over 5 days. Discussion: Amiodarone is associated with dose-dependent hepatotoxicity, particularly at chronic doses >400 mg/day. In this case, the overdose occurred due to inadequate communication in a high-risk LEP patient. Concomitant atorvastatin likely compounded hepatic stress. While influenza may have played a role, the temporal association and resolution upon drug discontinuation confirm drug-induced injury. This case underscores the clinical consequences of unaddressed language barriers and highlights the need for professional interpreter use and multilingual medication education in patients prescribed high-risk therapies. This case illustrates how communication failure in LEP patients can lead to life-threatening drug toxicity. Ensuring access to certified interpreters, visual medication guides, and structured patient education is essential to reducing preventable harm and improving medication safety in diverse patient populations.