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Hepatic derangement following N‐Acetylcysteine enemas in an infant with cystic fibrosis
Author(s) -
Cooke Andrew,
Deshpande Aniruddh V,
Wong Chris KF,
Cohen Ralph
Publication year - 2008
Publication title -
journal of paediatrics and child health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.631
H-Index - 76
eISSN - 1440-1754
pISSN - 1034-4810
DOI - 10.1111/j.1440-1754.2008.01399.x
Subject(s) - medicine , derangement , acetylcysteine , cystic fibrosis , enema , pediatrics , gastroenterology , chemistry , antioxidant , biochemistry , mathematics , combinatorics
We discuss an infant with MI secondary to cystic fibrosis, who was managed surgically by a double barrel ileostomy for mid – small bowel atresia and developed severe faecal impaction in the post – operative period. The faecal impaction was treated successfully with oral NAC and 0.2% NAC contrast enemas. The patient's liver function tests revealed a dramatic increase in transaminases and bilirubin contemporaneous with the administration of the enemas. The levels showed a spontaneous improvement after discontinuation. This is only the second reported case of hepatotoxicity secondary to NAC enemas in the literature. While our experience offers modest support for the use of NAC, its efficacy is not yet proven and paediatric surgeons using NAC in the enema form need to closely monitor liver function contemporaneous with this agent's administration and adjust their treatment accordingly.