Drug-induced Acute Liver Failure in Children

Introduction: Acute liver failure (ALF) is a syndrome characterized by jaundice, coagulopathy (INR >1.5) and hepatic encephalopathy in patients with no evidence of prior liver disease. Liver injury due to toxins and drugs is one of the most common aetiology of ALF in children.

Methods: In the last years, in our country the drugs ingestion is growing especially among adolescents. Methods: We have analysed retrospectively all patients who developed ALF after drugs exposure, hospitalized between January 2012 and December 2016 in our hospital, the main Toxicology Centre in Nord-Western Romania.

Results: During the last 5 years the number of drug-induced ALF increased dramatically: 20 cases (one case in 2012, two cases in 2013, three cases in 2014, four cases in 2015 and 10 cases in 2016). The most common drugs that caused toxic hepatitis with ALF were: acetaminophen (16 cases), albendazole (3 cases), valproate (2 cases) and colchicine (one case). Fortunately, the use of acetylcystein as an antidote in acetaminophen intoxication (one of the most used drug for suicide among teenagers in our region) makes mortality among these cases to remain low. Only one patient died: a teenager who ingested voluntary sixty colchicine tablets.

Conclusions: Unfortunately, in the last 5 years the incidence of teenagers who used drugs for suicide purposes is on the rise in our area. The most commonly used is acetaminophen due to the easy access to it, being released without medical prescription. Many of these drugs used in excess are toxic for the liver and in the severe cases can cause ALF or death.