Life-threatening hyponatremia due to intravenous n-acetylcysteine treatment in an infant: a case report

INTRODUCTION: N-acetylcysteine has proven to be effective in paracetamol intoxications, but there is no consensus regarding its way of administration. Here, we report a case to highlight the importance of careful management of intravenous n-acetylcysteine. CASE PRESENTATION: A two-month old infant was seen in our paediatric emergency department due to paracetamol poisoning after repeated supratherapeutic doses. She was treated with intravenous n-acetylcysteine diluted with dextrose 5%, according to the 20-hour standard protocol. Eight hours later she developed two tonic-clonic seizures and was subsequently intubated. By that time, she had received almost 1 liter of 5% dextrose, and serum sodium was 114 mg/dL. A rapid correction was done with hypertonic saline and the child experienced a good outcome, without any sequelae. CONCLUSION: Intravenous n-acetylcysteine administration must be done carefully. Amount of liquid administrated and sodium monitoring should be kept in mind, with special care in small children.