Question:
Which of the following is used as a specific treatment in certain cases of drug-induced liver failure?
Which of the following is used as a specific treatment in certain cases of drug-induced liver failure?
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Antidotes in Pediatric Acute Liver Failure:
$\bullet$ Acetaminophen Toxicity $\rightarrow$ N-Acetylcysteine (NAC)
$\bullet$ Valproate Toxicity Hyperammonemia $\rightarrow$ L-Carnitine (Levocarnitine)
$\bullet$ Mushroom (Amanita phalloides) Poisoning $\rightarrow$ Silibinin High-dose Penicillin G.
$\bullet$ Acetaminophen Toxicity $\rightarrow$ N-Acetylcysteine (NAC)
$\bullet$ Valproate Toxicity Hyperammonemia $\rightarrow$ L-Carnitine (Levocarnitine)
$\bullet$ Mushroom (Amanita phalloides) Poisoning $\rightarrow$ Silibinin High-dose Penicillin G.
Updated On: Sep 3, 2026
- Zinc
- L-carnitine
- Ursodeoxycholic acid
- Vitamin E
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Verified By Collegedunia
The Correct Option is B
Solution and Explanation
Concept:
Drug-Induced Liver Injury (DILI) and acute drug-induced liver failure (ALF) in children can occur secondary to predictable intrinsic hepatotoxins (such as acetaminophen) or idiosyncratic/metabolic toxins (such as sodium valproate).
Specific antidotal and targeted metabolic rescue therapies are indicated for particular pharmaceutical toxicities.
Explanation:
• Valproic acid (VPA)-induced hepatotoxicity and hyperammonemic encephalopathy is a severe, life-threatening metabolic drug reaction seen particularly in young children ($<2$ years) and those with underlying mitochondrial disorders (e.g., POLG mutations).
• Valproate metabolites inhibit the mitochondrial enzyme carnitine palmitoyltransferase I (CPT-1) and sequester free carnitine into valproylcarnitine, causing secondary systemic carnitine deficiency and impaired mitochondrial fatty acid beta-oxidation.
• Furthermore, valproate inhibits carbamoyl phosphate synthetase I (CPS-1), disrupting the urea cycle and driving acute hyperammonemia and hepatic failure.
• L-Carnitine (Levocarnitine) supplementation (given intravenously at $100\text{ mg/kg}$ loading, then $50\text{ mg/kg}$ q8h) is the established, guideline-recommended specific antidote.
• L-carnitine restores free carnitine pools, enhances mitochondrial fatty acid oxidation, promotes urinary excretion of valproylcarnitine, and rapidly lowers toxic ammonia levels.
• N-acetylcysteine (NAC) is the specific antidote for acetaminophen toxicity.
• Zinc is used in Wilson disease; Ursodeoxycholic acid is used in cholestatic disorders; Vitamin E is an antioxidant.
Final Answer:
L-carnitine is the specific targeted treatment used in valproate-induced acute liver failure and hyperammonemia.
Drug-Induced Liver Injury (DILI) and acute drug-induced liver failure (ALF) in children can occur secondary to predictable intrinsic hepatotoxins (such as acetaminophen) or idiosyncratic/metabolic toxins (such as sodium valproate).
Specific antidotal and targeted metabolic rescue therapies are indicated for particular pharmaceutical toxicities.
Explanation:
• Valproic acid (VPA)-induced hepatotoxicity and hyperammonemic encephalopathy is a severe, life-threatening metabolic drug reaction seen particularly in young children ($<2$ years) and those with underlying mitochondrial disorders (e.g., POLG mutations).
• Valproate metabolites inhibit the mitochondrial enzyme carnitine palmitoyltransferase I (CPT-1) and sequester free carnitine into valproylcarnitine, causing secondary systemic carnitine deficiency and impaired mitochondrial fatty acid beta-oxidation.
• Furthermore, valproate inhibits carbamoyl phosphate synthetase I (CPS-1), disrupting the urea cycle and driving acute hyperammonemia and hepatic failure.
• L-Carnitine (Levocarnitine) supplementation (given intravenously at $100\text{ mg/kg}$ loading, then $50\text{ mg/kg}$ q8h) is the established, guideline-recommended specific antidote.
• L-carnitine restores free carnitine pools, enhances mitochondrial fatty acid oxidation, promotes urinary excretion of valproylcarnitine, and rapidly lowers toxic ammonia levels.
• N-acetylcysteine (NAC) is the specific antidote for acetaminophen toxicity.
• Zinc is used in Wilson disease; Ursodeoxycholic acid is used in cholestatic disorders; Vitamin E is an antioxidant.
Final Answer:
L-carnitine is the specific targeted treatment used in valproate-induced acute liver failure and hyperammonemia.
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