Hepatotoxicity induced by acute and chronic paracetamol overdose in children: Where do we stand?

Abstract

Chronic paracetamol poisoning is a potential risk factor for hepatotoxicity and acute liver failure. Delays in seeking medical help might be a contributing factor. Clinicians should have a higher index of clinical suspicion for this entity.

Acute and chronic paracetamol overdose in paediatric population: Protocol of a prospective study of cohort to evaluate clinic factor and biomarkers to predict development of hepatotoxicity

“…It was evidenced that patients with chronic intake were more likely to develop hepatic encephalopathy at any time of clinical evolution than patients with acute ingestion. Similar results were obtained in the study conducted at our hospital, where retrospectively evaluated cases with suspected paracetamol intake in both adults and children, it was observed that patients with chronic paracetamol intake were at higher risk of developing ALF than patients with acute ingestion (8,13) .…”

“…In an epidemiological study, the relative risk (RR) of acute liver failure with therapeutic doses of paracetamol was 7 (CI 99%: 3.3 -13.9) with an estimated incidence rate of 2.4 cases per 100,000 person-years of exposure (11) . In our retrospective study, we found that only 1 of 49 patients with acute poisoning showed hepatotoxicity, whereas 7 of 8 patients with chronic poisoning showed hepatotoxicity, of which 3 met criteria of acute liver failure (8) .…”

“…In a retrospective study conducted by our group between 2005 and 2010, the incidence of paediatric paracetamol intoxication was 0.8 [Poisson-95% confi dence interval (CI): 0.03-3.69] per 10.000 inhabitants aged less than 18 years. The most common cause of poisoning was attempted suicide (47.8%) in teenagers with a median of age of 15 years, followed by accidental poisoning (42.2%) in babies with a median of age of 2.65 years (8) .…”

Парацетамол Среди Средств Суицидальных Действий В России И Зарубежом

“…In children, on the contrary, random poisoning prevails [54,56]. For the elderly, suicidal attempts are not characteristic: self-medication, accidental poisoning or the erroneous use of multicomponent drugs, which include paracetamol, predominate [27,39].…”

“…2), то доля преднамеренных самоотравлений с участием препарата значительно выше -от 47,8 до 90%, а в отдельных регионах, социальных или возрастных группах может приближаться практически к 100%. Table 2 Доля преднамеренных самоотравлений при передозировке парацетамола, % / The proportion of intentional self-poisoning in case of an overdose of Paracetamol, % Страна / Сountry % Австралия / Australia [23,26] 85-90 Швеция / Sweden [36] 85 Швейцария / Switzerland [37] 79 Сингапур / Singapore [24] 76,8 Польша / Poland [38] 68,2 Испания / Spain [39] 47,8 Россия / Russia [21] 60* Беларусь / Belarus [40] 78,6* *Для всех отравлений медикаментами / *for all drug poisonings Например, в Австралии лишь 0,02% подростков сообщали о случайном супратерапевтическом приёме парацетамола [25].…”