Recovery of acetaminophen-induced fulminant hepatic failure and encephalopathy after ten days of intravenous N-acetylcysteine administration in twin boys

We describe a case of liver failure in twin infants after frequent therapeutic doses of acetaminophen over 4 days at home to manage pyrexia due to a viral illness. The children were treated successfully with intravenous N-acetylcysteine (NAC) following the hospital’s protocol. This case highlights the importance of parental awareness of acetaminophen hepatotoxicity and physicians’ advice to parents in preventing hepatotoxicity induced by acetaminophen overdose during viral illness. Although Twin 1 met the King’s College Hospital criteria for liver transplantation, he was successfully treated with intravenous N-acetylcysteine for 10 days.