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Fulminate Hepatic Failure in a 5 Year Old Female after Inappropriate Acetaminophen Treatment

Irena Kasmi1, Sashenka Sallabanda1, Gentian Kasmi2

  • 1Pediatric Department University Hospital Center, Tirana, Albania.

Open Access Macedonian Journal of Medical Sciences
|June 9, 2016
PubMed

Insights

Pediatric acetaminophen toxicity can cause severe liver failure and pancreatitis, even from unintentional overdoses. Early N-acetylcysteine (NAC) treatment is crucial for recovery in children with acetaminophen poisoning.

Area of Science:

  • Pediatric Toxicology
  • Hepatology
  • Clinical Pharmacology

Background:

  • Acetaminophen is a common pediatric medication, generally safe but with risks of toxicity from overdoses.
  • While less common than in adults, acetaminophen toxicity can occur in children due to intentional or unintentional supratherapeutic dosing.
  • This case highlights the potential for severe adverse events in pediatric patients receiving high doses of acetaminophen.

Observation:

  • A 5-year-old girl experienced fulminant liver failure, renal impairment, and acute pancreatitis from unintentional acetaminophen overdose (4800 mg over 3 days).
  • Clinical presentation included fever, jaundice, lethargy, encephalopathy, and significantly elevated liver enzymes (ALT 5794 UI/l, AST 6000 UI/l).
  • The patient also developed acute pancreatitis with markedly elevated amylase and lipase levels.

Findings:

  • Early administration of oral N-acetylcysteine (NAC) led to rapid improvement in liver enzymes, hepatic function, and encephalopathy.
  • Despite the severity of liver injury and pancreatitis, the child made a full recovery within 29 days.
  • Blood acetaminophen levels were 32 mg/l ten hours after the last dose, indicating significant ingestion.

Implications:

  • Healthcare providers must consider acetaminophen toxicity in pediatric patients presenting with liver failure, especially after recent drug administration.
  • Prompt initiation of N-acetylcysteine (NAC) is vital when acetaminophen toxicity is suspected, continuing treatment until hepatic function normalizes.
  • This case underscores the importance of careful dosing and monitoring of acetaminophen in children to prevent severe, potentially fatal, toxicity.
Abstract

Keywords:
NACacetaminophenliver failurepancreatitistoxicity

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