Información adicional

• Num_publicacion 71(7)
• Resumen_ingles

  Acute liver failure (ALF) in children is a rare but often fatal condition. Drugs are the second most common identified cause in most of the series in children. Acetaminophen is the most frequent agent in these patients, even when it is administered in correct dosage. We present two acute liver failure cases without evident cause, in which acetaminophene could be a determinant agent. An infant with bronchiolitis complicated with bacterial sobreinfection, who presents ALF. ALF is attributed to possible acetominophen idiosyncrasy, enhanced by hepatic hypoperfusion; rejecting hemodynamic instability as the only cause because its mild and late nature. Another infant who presents ALF in context of hypernatremic dehidratation secondary to acute gastroenteritis. Metabolic study is compatible with a deficit of 3-OH methyl-glutaryl-CoA lyase (not confirmed by molecular study). It is considered possible b-oxidation inhibition exacerbated by acetaminophen (idiosyncrasy) and enhanced by liver hypoperfusion due to severe dehydration. In both cases, we use N-acetylcysteine (NAC) as part of ALF treatment; the course is favorable, normalizing liver function. The accumulation of acetaminophen toxic metabolite in a previously damaged liver can worsen its function. We must request its level in every patient with ALF who have received this drug, given its toxicity based on the time after administration. The administration of NAC to children with ALF not caused by acetaminophen toxicity appeared to be safe and may be associated with a better outcome.

• Palabras_clave_ingles Acute liver failure Acetaminophen N acetyscysteine
• Todos_autores P. Madurga Revilla, J.P. García Íñiguez, D. Palanca Arias, R. Conchello Monleón, M.L. Rodríguez Sanz, I. García Oses, I. García Jiménez
• autores listados P. Madurga Revilla, J.P. García Íñiguez, D. Palanca Arias, R. Conchello Monleón, M.L. Rodríguez Sanz, I. García Oses, I. García Jiménez
• Correspondecia
  P. Madurga Revilla. Vía Univérsitas, 10, portal 3, 2.º B. 50009 Zaragoza.
  Correo electrónico: paumare@hotmail.com
• Titulo_ingles Acetaminophen and acute liver failure, was it the last thing needed?
• Centros_trabajo Unidad de Cuidados Intensivos Pediátricos y Unidad de Metabolopatías. Hospital Infantil Universitario «Miguel Servet». Zaragoza
• Publicado en Acta Pediatr Esp. 2013; 71(7): e199-e203
• copyright ©2013 Ediciones Mayo, S.A.
• Fecha recepcion 8/08/12
• Fecha aceptacion 17/10/12