case_images: PMC9909444_01
case_images: Laboratory results during the patient's admission to the pediatric intensive care unit. Trends in pH, lactate, INR, aspartate aminotransferase (AST), alanine aminotransferase (ALT), ammonia, and creatinine over the course of the patient's admission. Pink shaded areas on each graph represent values that fall outside of the normal range for that blood test. Blue line indicates the timepoint where the N-acetylcysteine (NAC) infusion was increased to six-times the intended dose (72 mg/kg/h).
case_images: crg-2022-0017-0001-529169_f1.jpg
case_images: PMC9909444_01_crg-2022-0017-0001-529169_f1.jpg
case_images: F1
case_images: Repeat laboratory investigations found some improvement in liver function (shown in Fig. 1).
case_images: Timelines of clinical and therapeutic events during the patient's admission to the pediatric intensive care unit. Timeline of events showing the patient's clinical findings, alongside changes to the N-acetylcysteine (NAC) infusion rate. The arrow highlights the duration of time during which the NAC infusion ran at six-times the intended dose (72 mg/kg/h) prior to declaration of brain death. CRRT, continuous renal replacement therapy; TPE, total plasma exchange.
case_images: crg-2022-0017-0001-529169_f2.jpg
case_images: PMC9909444_01_crg-2022-0017-0001-529169_f2.jpg
case_images: F2
case_images: Failure to recognize the dosing error resulted in the patient receiving the incorrect dose for 57 h prior to the diagnosis of brain death, and for a total of 78 h as described below (shown in Fig. 2). She developed agitation and worsening headache within 2 h of the dosing error, and these progressed to seizure and intubation 14 h into the dosing error (shown in Fig. 2).