N-acetyl cysteine in non-acetaminophen pediatric acute liver failure: recent evidence!

We read with interest the current consensus statement on management of acute liver failure in infants and children [1]. Pediatric acute liver failure (ALF) is a devastating disease in which previously healthy children rapidly lose hepatic function due to a variety of causes and become critically ill within days. Management is largely supportive and only few conditions are amenable to directed therapy, such as acute acetaminophen toxicity. N-acetyl cysteine (NAC) replenishes mitochondrial and cytosolic glutathione stores and is the treatment of choice for acute acetaminophen toxicity. Studies in the past have shown some role of NAC in non-acetaminophen ALF [2,3].