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Generation of a Rat Model of Acute Liver Failure by Combining 70% Partial Hepatectomy and Acetaminophen
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High Risk Acetaminophen Ingestion in a Nine-Month-Old Requiring Hemodialysis: A Case Report

Camille Mero1, Raven Haan1, Sandra Al Tamimi2

  • 1Herman and Walter Samuelson Children's Hospital, Pediatric Residency.

Pediatric Emergency Care
|April 8, 2026
PubMed

Insights

High-risk acetaminophen overdose in infants requires prompt treatment with N-acetylcysteine (NAC) and extracorporeal toxin removal. This case highlights successful multimodal management, including hemodialysis and continuous renal replacement therapy, preventing liver failure.

Area of Science:

  • Pediatric Toxicology
  • Critical Care Medicine
  • Pharmacology

Background:

  • Acetaminophen (APAP) overdose in infants is rare but can lead to rapid metabolic decline and mitochondrial dysfunction.
  • Limited pediatric-specific management guidelines exist for severe APAP poisoning.
  • Early recognition and intervention are critical for survival in infant APAP overdose.

Purpose of the Study:

  • To present a case of successful multimodal management of high-risk acetaminophen poisoning in an infant.
  • To highlight practical considerations for N-acetylcysteine (NAC) dosing during extracorporeal toxin removal.
  • To underscore public health concerns related to medication accessibility and formulation in pediatric ingestions.

Main Methods:

  • A 9-month-old infant ingested a large dose of acetaminophen, presenting with altered mental status, severe metabolic acidosis, coagulopathy, and respiratory failure.
  • Treatment involved high-dose N-acetylcysteine (NAC), fomepizole, intermittent hemodialysis (HD), and continuous renal replacement therapy (CRRT).
  • Management included aggressive phosphorus repletion and prolonged mechanical ventilation.

Main Results:

  • The infant survived without progression to acute liver failure.
  • Extracorporeal toxin removal (HD and CRRT) was a key component of the successful treatment.
  • NAC dose adjustments were necessary during renal replacement therapy.

Conclusions:

  • Multimodal management, including extracorporeal toxin removal and adjunctive therapies, can be effective for severe infant acetaminophen poisoning.
  • Practical challenges in NAC dosing during renal replacement therapy were addressed.
  • Public health strategies, such as limiting acetaminophen quantities and discouraging child-attractive formulations, are needed to prevent severe ingestions.
Abstract

Keywords:
N-acetylcysteineacetaminophenacute respiratory distress syndromecontinuous renal replacement therapyfomepizolehemodialysispediatric toxicology

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