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J Pediatr Intensive Care 2021; 10(02): 159-161
DOI: 10.1055/s-0040-1712158
Case Report

Continuous Venovenous Hemofiltration as a Rescue Therapy for Severe Acetaminophen Toxicity in a Toddler

Puspraj Awasthi
1   Division of Pediatric Critical Care, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education & Research, Chandigarh, India
,
Ankush Jindal
1   Division of Pediatric Critical Care, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education & Research, Chandigarh, India
,
Yogish Sharma
1   Division of Pediatric Critical Care, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education & Research, Chandigarh, India
,
Vijai Williams
1   Division of Pediatric Critical Care, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education & Research, Chandigarh, India
,
Namita Ravikumar
1   Division of Pediatric Critical Care, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education & Research, Chandigarh, India
,
Karthi Nallasamy
1   Division of Pediatric Critical Care, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education & Research, Chandigarh, India
,
Suresh Kumar Angurana
1   Division of Pediatric Critical Care, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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Abstract

Acetaminophen poisoning is one of the common accidental poisoning in children. Accidental administration of mismatched doses of drops for syrups can lead to life-threatening overdose. N-acetylcysteine (NAC) is the specific antidote; however, extracorporeal therapy such as continuous venovenous hemofiltration (CVVH) can be used as a rescue measure when there is no improvement despite adequate NAC therapy and can be lifesaving. We reported an 18-month-old male infant patient who presented with acetaminophen poisoning following accidental ingestion of acetaminophen drops in place of syrup and developed fulminant hepatic failure. Treatment with NAC did not lead to improvement and CVVH was used as a rescue therapy for 24 hours which led to dramatic clinical and biochemical improvement with intact neurological outcome.

Keywords

continuousvenovenous hemofiltration - acetaminophen - poisoning


Publication History

Received: 20 January 2020

Accepted: 17 April 2020

Article published online:
22 May 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
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  • References

  • 1 Rajanayagam J, Bishop JR, Lewindon PJ, Evans HM. Paracetamol-associated acute liver failure in Australian and New Zealand children: high rate of medication errors. Arch Dis Child 2015; 100 (01) 77-80
    CrossrefPubMedGoogle Scholar
  • 2 Bunchorntavakul C, Reddy KR. Acetaminophen (APAP or N-acetyl-p-aminophenol) and acute liver failure. Clin Liver Dis 2018; 22 (02) 325-346
    CrossrefPubMedGoogle Scholar
  • 3 Larsen FS, Schmidt LE, Bernsmeier C. et al. High-volume plasma exchange in patients with acute liver failure: an open randomised controlled trial. J Hepatol 2016; 64 (01) 69-78
    CrossrefPubMedGoogle Scholar
  • 4 Wu ML, Tsai WJ, Deng JF, Yang CC. Hemodialysis as adjunctive therapy for severe acetaminophen poisoning: a case report. Zhonghua Yi XueZaZhi (Taipei) 1999; 62 (12) 907-913
    PubMedGoogle Scholar
  • 5 Ghannoum M, Kazim S, Grunbaum AM, Villeneuve E, Gosselin S. Massive acetaminophen overdose: effect of hemodialysis on acetaminophen and acetylcysteine kinetics. ClinToxicol (Phila) 2016; 54 (06) 519-522
    CrossrefPubMedGoogle Scholar
  • 6 Kiernan EA, Fritzges JA, Henry KA, Katz KD. A case report of massive acetaminophen poisoning treated with a novel “triple therapy”: N-acetylcysteine, 4-methylpyrazole, and hemodialysis. Case Rep Emerg Med 2019; 2019: 9301432
    PubMedGoogle Scholar
  • 7 Gosselin S, Juurlink DN, Kielstein JT. et al; EXTRIP Workgroup. Extracorporeal treatment for acetaminophen poisoning: recommendations from the EXTRIP workgroup. ClinToxicol (Phila) 2014; 52 (08) 856-867
    CrossrefPubMedGoogle Scholar
  • 8 Agarwal R, Farber MO. Is continuous veno-venous hemofiltration for acetaminophen-induced acute liver and renal failure worthwhile?. ClinNephrol 2002; 57 (02) 167-170
    PubMedGoogle Scholar
  • 9 Hernandez SH, Howland M, Schiano TD, Hoffman RS. The pharmacokinetics and extracorporeal removal of N-acetylcysteine during renal replacement therapies. ClinToxicol (Phila) 2015; 53 (10) 941-949
    CrossrefPubMedGoogle Scholar
  • 10 Wong A, Tong RLK, Ryan L, Crozier T, Graudins A. The use of sustained low efficiency dialysis (SLED) in massive paracetamol overdose. ClinToxicol (Phila) 2018; 56 (03) 229-231
    CrossrefPubMedGoogle Scholar
  • 11 Campion GH, Wang JJ, Hoffman RS. et al. Extracorporeal treatments in poisonings from four non-traditionally dialysed toxins (acetaminophen, digoxin, opioids and tricyclic antidepressants): a combined single-centre and national study. Basic ClinPharmacolToxicol 2019; 124 (03) 341-347
    PubMedGoogle Scholar
  • 12 Raina R, Grewal MK, Blackford M. et al. Renal replacement therapy in the management of intoxications in children: recommendations from the Pediatric Continuous Renal Replacement Therapy (PCRRT) workgroup. PediatrNephrol 2019; 34 (11) 2427-2448
    PubMedGoogle Scholar
  • 13 Bunchorntavakul C, Reddy KR. Acetaminophen-related hepatotoxicity. Clin Liver Dis 2013; 17 (04) 587-607 , viii
    CrossrefPubMedGoogle Scholar
  • 14 Serper M, Wolf MS, Parikh NA, Tillman H, Lee WM, Ganger DR. Risk factors, clinical presentation, and outcomes in overdose with acetaminophen alone or with combination products: results from the Acute Liver Failure Study Group. J ClinGastroenterol 2016; 50 (01) 85-91
    PubMedGoogle Scholar
  • 15 Marzullo L. An update of N-acetylcysteine treatment for acute acetaminophen toxicity in children. CurrOpinPediatr 2005; 17 (02) 239-245
    PubMedGoogle Scholar
  • 16 Rumack BH, Bateman DN. Acetaminophen and acetylcysteine dose and duration: past, present and future. ClinToxicol (Phila) 2012; 50 (02) 91-98
    CrossrefPubMedGoogle Scholar