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Acute liver failure associated with a prolonged course of acetaminophen at recommended dosages in paediatric age

A Gentili1, M E Latrofa, L Giuntoli

  • 1Department of Paediatric Anaesthesia and Intensive Care, S. Orsola-Malpighi University Hospital, Via Massarenti, 9-40138 Bologna. andrea_gentili@libero.it

La Pediatria Medica E Chirurgica : Medical and Surgical Pediatrics
|May 13, 2009
PubMed

Insights

Acetaminophen is generally safe for children, but overdose can cause liver failure. This case shows spontaneous recovery from severe liver injury despite prolonged, recommended acetaminophen use.

Area of Science:

  • Pediatric pharmacology
  • Hepatology
  • Clinical toxicology

Background:

  • Acetaminophen (APAP) is a widely used analgesic and antipyretic in pediatric populations.
  • While generally safe at recommended doses, APAP overdose is a leading cause of acute liver failure (ALF).
  • The established understanding links severe hepatotoxicity to supratherapeutic ingestions.

Observation:

  • This report details a rare case of a pediatric patient.
  • The patient experienced fulminant liver failure (FLF).
  • FLF occurred during a prolonged course of acetaminophen administered at recommended therapeutic dosages.

Findings:

  • The patient demonstrated spontaneous, complete recovery from the severe liver injury.
  • This outcome challenges the typical dose-dependent toxicity model for acetaminophen-induced liver injury.
  • The case highlights the potential for idiosyncratic reactions even at recommended doses.

Implications:

  • This case suggests that prolonged acetaminophen use, even at recommended dosages, may pose a risk for idiosyncratic acute liver failure in children.
  • Further investigation into the mechanisms of acetaminophen hepatotoxicity and individual susceptibility is warranted.
  • Clinical vigilance for acetaminophen-induced liver injury should extend beyond overdose scenarios.

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