Acute liver failure due to Cassia floribunda: case report of three children from a family.

Liver is the largest and most vital organ in human body and able to detoxify several chemical compounds. Acute liver failure (ALF) is a rare devastating process that can leads to urgent liver transplantation. In this study we introduce 3 children of a family with an accidental intoxication of Cassia Floribunda which causes ALF. The first case is a four-year-old girl with an icter's complaints and drowsiness after eaten plant in the garden while playing with her sister and friend 3 days ago. At the beginning her GCS was 10, vital signs were normal, sclera was icteric and pupil has normal size and was reactive to the light. Initial tests showed leukopenia, anemia, thrombocytopenia, increase of liver enzymes , coagulopathy , hypoglycemia. With diagnosis, fulminant liver deficiency and hepatic encephalopathy, the patient transferred to PICU and GCS reduced. her general appearance became better ,consciousness increased, lab test findings improvedand and discharged after 11 days.Second and third cases presented to emergency with similar complaints without icteric, vital signs and other examinations were normal . Initial tests reported reduced platelets, increase liver enzymes , Without hypoglycemia. treatment was started for patient by intravenous ranitidine and monitored in emergency . Two days after discharged. But in third case platelets increased.ALF in children is a serious problem that can lead to death or need to liver transplantation. When evaluate the causes of ALF, poisoning due to plants should be kept in.