Abstract
Abstract: Liver is the largest and most vital organ in human body and able to detoxify several chemical compounds. Acute liver failure (ALF) is a rare devastating process that can leads to urgent liver transplantation. It is true incidence in the pediatric population is unknown. The true prevalence of herbal product use and incidence of herbal hepatotoxicity are unknown. Cassia and Senna plants are traditional medicine. Hepatotoxicity of it indicates that, there is a time-lag between herbal intake and hepatotoxicity increase. The real incidence of hepatic symptoms as a complication of herbal remedies has not been identified yet. But it is estimated that the incidence of hepatotoxicity is 0.2-1%.In this study we introduce 3 children of a family with an accidental intoxication of Cassia Floribunda which causes ALF.
Case report: The first case is a four-year-old girl with an icter's complaints and drowsiness after eaten plant in the garden while playing with her sister and friend 3 days ago. 2 days before admission, she suffered from nausea, vomiting and icterus, about 24 hour later malaise, hallucinations and delusions added to patient symptoms,. At the beginning her GCS was 10, vital signs were normal, sclera was icteric and pupil has normal size and was reactive to the light. Initial tests showed leukopenia, anemia, and thrombocytopenia, increase of liver enzymes, coagulopathy, and hypoglycemia. With diagnosis, fulminant liver deficiency and hepatic encephalopathy, the patient transferred to PICU and GCS reduced. Her general appearance became better, consciousness increased, lab test findings improved and discharged after 11 days. Second and third cases presented to emergency with similar complaints without icteric, vital signs and other examinations were normal. Initial tests reported reduced platelets, increase liver enzymes, without hypoglycemia. Treatment was started for patient by intravenous ranitidine and monitored in emergency. Two days after discharged. But in third case platelets increased.