title: Early treatment with N-acetylcysteine in children with acute liver failure secondary to hepatitis A.
abstract: BACKGROUND
  Hepatitis A virus can evolve to acute liver failure with a fatal outcome if it is not reversed.
  
  
  OBJECTIVE
  We describe the clinical course of 12 children who presented with hepatitis A acute liver failure and received treatment with oral N-acetylcysteine (NAC).
  
  
  METHODS
  Of the seventy-two patients with viral hepatitis A, 12 patients who had acute hepatic failure were included. The variables evaluated were age, sex, duration of clinical features prior to hospitalization, signs and symptoms, laboratory parameters [alanine aminotransferase (ALT), aspartate aminotransferase (AST), prothrombin time (PT), partial thromboplastin time (PTT), internal normalization ratio and ammonia], treatment (oral NAC 100 mg/kg/day, lactulose, neomycin and general measures) and clinical course during hospitalization.
  
  
  RESULTS
  Six males and six females were included. School-aged and adolescent children predominated. All presented with jaundice, nausea, vomiting and hepatomegaly. Two had stage 2 neurological signs as per the West-Haven scale. All had altered laboratory parameters. All received NAC, six patients for a week and the remaining six for 9-36 days. Treatment was not ceased until patients showed clinical and laboratory improvement. All data were analyzed using both student's t test and Wilcoxon signed rank with alpha = 0.05, the ALT with P = 0.0003 and 0.005, AST with P = 0.0001 and 0.0005, PT with P = 0.0237 and 0.0005, PTT with P = 0.0515 and 0.0039, ammonia with P = 0.0197 and 0.0015 and direct bilirubin with P = 0.0190 and 0.068. There was good tolerance to medications and a satisfactory clinical course.
  
  
  CONCLUSIONS
  The use of oral NAC appears to be an effective therapeutic alternative for hepatitis A-induced liver failure if it is offered appropriately. It can modify the clinical course to a favorable one and prevent the fatal outcome of hepatic encephalopathy.
authors.affiliation: Departament of Pediatric Internal Medicine. Norbertosotelo5@hotmail.com
authors.forename: Norberto
authors.initials: N
authors.lastname: Sotelo
authors.forename: María
authors.initials: M
authors.lastname: de los Angeles Durazo
authors.forename: Alejandro
authors.initials: A
authors.lastname: Gonzalez
authors.forename: Nagasharmila
authors.initials: N
authors.lastname: Dhanakotti
mesh_terms: D000111:Acetylcysteine / Q000008:administration & dosage / Q000627:therapeutic use*; D000284:Administration, Oral; D000293:Adolescent; D000410:Alanine Transaminase / Q000097:blood; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001219:Aspartate Aminotransferases / Q000097:blood; D002648:Child; D004359:Drug Therapy, Combination; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D006506:Hepatitis A / Q000097:blood / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D007792:Lactulose / Q000627:therapeutic use; D017114:Liver Failure, Acute / Q000097:blood / Q000188:drug therapy* / Q000209:etiology*; D008297:Male; D008800:Mexico; D009355:Neomycin / Q000627:therapeutic use; D011517:Prothrombin Time; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D000998:Antiviral Agents; D005765:Gastrointestinal Agents; D007792:Lactulose; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D009355:Neomycin; D000111:Acetylcysteine