ALF – NAC — RACP Paediatrics MCQ

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A 3-year-old presents with jaundice, coagulopathy (INR 5.2), encephalopathy, and hepatomegaly. ALT is >5000. The cause is indeterminate. What empirical treatment should be started immediately while investigations proceed?

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Correct answer: B — IV N-acetylcysteine

IV N-acetylcysteine (NAC) is recommended empirically in all paediatric acute liver failure regardless of aetiology (not just paracetamol overdose). Studies show improved transplant-free survival in non-paracetamol ALF with NAC use. It acts as an antioxidant and improves hepatic blood flow. Investigation for aetiology should proceed in parallel.

Reference: RCH Melbourne – 2023 – Acute Liver Failure CPG; RACP Paediatric Curriculum – GI