Successful Heat Stroke-Induced Pediatric Acute Liver Failure Treatment With N-Acetylcysteine Case Report

BACKGROUND: Previously healthy children are at risk of developing exertional heat stroke when experiencing extreme heat. Pediatric clinicians in primary care, emergency department, and critical care settings should be versed in the management of complications of exertional heat stroke. Pediatric acute liver failure (PALF) in the setting of heat stroke is rarely reported in published literature. CASE SUMMARY: A 9-year-old male presented with heat stroke-induced PALF. He initially presented to an emergency department for altered mental status. During his clinical course, despite appropriate identification and initial treatment of exertional heat stroke, his symptoms progressed, including ongoing agitation, hepatic encephalopathy, coagulopathy, and severe transaminase elevation meeting clinical criteria for PALF. CONCLUSIONS: He was treated with N-acetylcysteine (NAC) with resolution of his PALF without complications. In this article, we review the patient’s clinical course, the rationale for treatment with NAC, and the management of heat stroke-induced PALF.