Ryan A., 1

Ryan is the only child of his parents and lives with them in a modest two-room mud-walled house. His father is a peasant farmer who occasionally takes up casual jobs to support the family, while his mother is a homemaker. Both parents were unable to complete their education due to financial constraints and lack of school fees. According to his mother, Ryan had been in good health until she noticed that his skin had become dry and scaly. He also developed poor breastfeeding, episodes of diarrhoea, and swelling of the hands and feet. Concerned about his condition, she initially administered herbal remedies in the hope that he would improve. However, despite several days of home management, his symptoms persisted and gradually worsened. Alarmed by the lack of improvement, Ryan's father advised that he be taken to a nearby health facility for medical attention. Upon assessment, he was stabilized and subsequently referred to Siaya County Referral Hospital for further evaluation and specialized management.

Ryan was brought to the hospital with complaints of scaling of the skin, episodes of diarrhoea and in ability to feed properly. He was diagnosed with acute liver injury and hyperkalemia, which warranted admission. He was started on EBM at 60mls after every 3 hours, ORS after every loose stool. He was also administered hypertonic saline, dexamethasone, 10% dextrose among other drugs. He responded well to medication and was eventually discharged on orals.

A 4-month-old infant diagnosed with acute liver injury secondary to herbal intoxication and severe acute malnutrition (SAM) has a guarded to serious prognosis, depending on the extent of liver damage, nutritional status, and response to treatment. Baby Ryan however was brought to the hospital in time, where prompt medical intervention was done, he is thus expected to make a full recovery