Polygoni Multiflori Radix Praeparata and Tribuli Fructus-induced acute liver failure

A 14-year-old female patient took Polygoni Multiflori Radix Praeparata and Tribult Fructus decoction for vitiligo(dose not stated).Thirty-eight days later,she developed yellowish sclera and skin.She appeared disturbance of consciousness after 42 days.Laboratory tests revealed the following results:white blood cell count 13.8 x 10 /L,prothrombin time 27.6 s,prothrombin activity 24%,activated partial thromboplastin time 75.7 s,fibrinogen 1.08 g/L,alanine aminotransferase 510 U/L,aspartate aminotransferase 254 U/L,total bilirubin 395.7 μmol/L,direct bilirubin 319.4 μmol/L,ammonia 65 μmol/L,and urine bilirubin + + +.Drug-induced liver injury,acute liver failure,and hepatic encephalopathy were diagnosed.She was treated with glutathione,ademetionine 1,4-butanedisulfonate,compound amino acid,naloxone hydrochloride,Xingnaojing(酲脑静),aceglutamide,diisopropylamine dichloroacetate,polyene phosphatidylcholine,ornithine aspartate,omeprazole sodium and mannitol by intravenous infusion,nasal feeding lactulose oral solution,intermittent infusion of fresh frozen plasma and plasma exchange.On day 5,the patient's liver function improved and consciousness was restored.On day 16,she recovered well.