Treatment with N-Acetylcystein and Total Plasma Exchange for Extracorporeal Liver Support in Children with Paracetamol Intoxication

Background

Paracetamol is a well-established analgesic and antipyretic medication in children with a well-known safety profile. Inappropriate dosing may lead to intoxication with progressive hepatic necrosis and acute liver failure (Committee on Drugs, Pediatrics 2001; 108: 1020–1024). In the cases where antidote treatment with N-acetylcystein (NAC) fails to improve hepatic regeneration, survival of the children will depend on the feasibility of orthotropic liver transplantation (OLT). According to latter, criteria for the selection of patients have been reported (Bernal W et al., Lancet 2002; 359: 558–563). We herein report 2 children with paracetamol induced acute liver failure resulting in hepatic encephalopathy (HE), who were treated with NAC and total plasma exchange (TPE) while they were evaluated for OLT, but recovered without.