[Acute liver failure caused by paracetamol: should treatment with N-acetylcysteine be prolonged?].
BACKGROUND
Some cases of paracetamol-induced acute hepatic failure may require liver transplantation but the present shortage of graft urges the search for an alternate therapeutic approach.


METHODS
A 17 year-old girl was admitted for sleepingness and vomiting after about 15 hours of voluntary but denied absorption of paracetamol. Plasma paracetamol concentration was 120 mg/l; factors VII+X level were 55% and factor V 106%. The patient was given IV N-acetylcysteine, 150 mg/kg/30 min, then 50 mg/kg/4 hours. Further decrease in facteur VII level led to pursue administration of N-acetylcysteine (total dose: 350 mg/kg/2 hours). While indication of liver transplantation was considered, clinical and laboratory findings definitely improved.


CONCLUSIONS
N-acetylcysteine may be effective even if administered late. Repeated determination of factor VII could be a good means for managing such a severe condition.
Rey
C
C
Service de médecine pour adolescents, hôpital de Bicêtre, France.
Ajzenberg
N
N
Tchernia
G
G
Alvin
P
P
Dreyfus
M
M
D000082:Acetaminophen / Q000506:poisoning*; D000111:Acetylcysteine / Q000008:administration & dosage / Q000627:therapeutic use*; D000293:Adolescent; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D017114:Liver Failure, Acute / Q000139:chemically induced* / Q000188:drug therapy*
D000082:Acetaminophen; D000111:Acetylcysteine
Insuffisance hépatocellulaire aiguë au paracétamol: faut-il prolonger la durée du traitement par la N-acétyl cystéine?