Related Experiment Video
Updated: Jul 11, 2026
09:44
Generation of a Rat Model of Acute Liver Failure by Combining 70% Partial Hepatectomy and Acetaminophen
Published on: November 27, 2019
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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
Summary
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.
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