Early predictors of severe acetaminophen‐induced hepatotoxicity in a paediatric population referred to a tertiary paediatric department

Abstract

Paediatric patients at increased risk of severe hepatotoxicity were identified by early biochemical parameters, prehospital vomiting episodes and latency time before N-acetylcysteine initiation.

Early Risk Factors of Moderate/Severe Hepatotoxicity After Suicide Attempts With Acetaminophen in 11- to 15-Year-Old Children

“…In a study of 25 pediatric patients with severe hepatotoxicity admitted to a tertiary specialized department, we found no relationship between any of the biochemical parameters and the ingested amount of acetaminophen. 16 …”

“…In a study of pediatric patients with severe hepatotoxicity due to acetaminophen poisoning, we likewise found similar highly significant relationships between the number of episodes of prehospital vomiting and the relevant biochemical parameters. 16 We assume that a possible explanation of the lack of linear dose–response relationship could be that patients who develop severe hepatotoxicity or liver failure may have a different expression of cytochrome P450 than the age-adjusted background population, which results in higher levels of the hepatotoxic-free NAPQI compound at lower acetaminophen doses. Polymorphisms in genes encoding the acetaminophen glucuronosyltransferase enzymes have also recently been found in adults and have been related to the risk of acetaminophen-induced liver injury.…”

“…We have previously published a study of possible early risk factors of severe hepatotoxicity in a population admitted to a specialized tertiary pediatric department due to suicide attempt with acetaminophen. 16 …”

A clinician’s guide to self‐poisoning with paracetamol in youth: The what, when and why?

“…The presence of these gastrointestinal symptoms should be considered an alarm indicating high risk for severe hepatotoxicity. 24 In the adult population, clear laboratory criteria exist for paracetamol overdose and are available to aid clinicians in determining the most appropriate treatment pathway. 25 26 Although bilirubin may also rise, the level can also present as…”

“…26 Instead, the time since ingestion has been suggested as a more robust parameter. 24 In a United Kingdom transplant centre, delayed presentation (44 vs 24 hours) to hospital after overdose was a significant risk factor for severe hepatocellular injury with requirement for liver transplantation, and increased mortality. 26 Paracetamol is rapidly absorbed, within 30-45 mins of ingestion, with peak levels at 4 hours.…”