Case 1: A Toddler in Distress
A visibly anxious young mother rushed into the emergency department carrying her 2-year-old daughter, J.N. who appeared pale, fatigued, and restless. She had been vomiting repeatedly, was refusing food, and had developed rapid, shallow breathing. The mother reported that J.N. had a mild fever the previous day, for which she was prescribed syrup paracetamol from a nearby clinic. The dosage was handwritten and unclear. In an attempt to control the fever, the mother gave approximately four tablespoons (about 60 ml) of syrup unknowingly exceeding the safe dose for the child’s 11 kg weight.
By the next morning, J.N.’s condition had deteriorated. She was lethargic, crying continuously, bloated, and refusing feeds. On examination, she was tachycardic (180 bpm), tachypneic (50 breaths/min), dehydrated, and showed signs of jaundice. Her abdomen was distended with palpable hepatomegaly. the doctor ordered investigations.
Liver function tests revealed elevated ALT (400 U/L), AST (300 U/L), and total bilirubin (2.5 mg/dL). Random blood glucose was critically low at 18 mg/dL. Coagulation profile showed a PT of 20 seconds and INR of 2.0. Serum paracetamol level was 150 µg/mL
What is the most likely diagnosis in this case?