Paracetamol poisoning in children.

Meredith, T. Jason; Newman, Bernard; Goulding, Roy

doi:10.1136/bmj.2.6135.478-a

Cited by 36 publications

(8 citation statements)

References 1 publication

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“…It may occasionally be due to attempted suicide in older children and is rarely due to intentional poisoning in infants (Hickson et al, 1983(Hickson et al, , 1989). In Sydney the peak age group for children presenting with alleged toxic paracetamol ingestion over a 10 year period (1978)(1979)(1980)(1981)(1982)(1983)(1984)(1985)(1986)(1987)(1988) was 2-3 years (Lim, 1989: unpublished data), which was similar to the Denver (1976)(1977)(1978)(1979)(1980)(1981)(1982)(1983)(1984) (Rumack 1984) and the English experience (Meredith et al, 1978). In Denver children under the age of 5 years represented 4.6% of 9000 cases of paracetamol poisoning.…”

Section: Diagnostic Nomogramssupporting

confidence: 50%

“…Adults accounted for most of the serious and fatal cases. Young children represent a small proportion of significant paracetamol overdoses, and hepatic damage or death seems rare in this age group (Meredith et al, 1978). In the North American National Multicenter Study (1976 to 1985) (Smilkstein et al, 1988) there were 50 deaths from 11195 paracetamol overdoses, and 3.3% of all patients were under the age of 5 years.…”

Section: Introductionmentioning

confidence: 99%

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Paracetamol poisoning in children and hepatotoxicity.

Penna

Buchanan

1991

Brit J Clinical Pharma

149

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1. Paracetamol is one of the most common drugs that children accidentally ingest. Unlike the situation in adults, death and hepatotoxicity in children from paracetamol poisoning are exceedingly uncommon events. A review of the literature has revealed only seven deaths and fourteen cases of hepatotoxicity in children, with most of the cases resulting from chronic poisoning and not acute poisoning. 2. Children may be less prone to paracetamol hepatotoxicity because of developmental differences in the drug's metabolism and its pathways of detoxification. In the therapeutic setting of treatment of fever and pain in children, paracetamol is regarded as a drug with a higher therapeutic index, and as such, there seems to be little concern with strict adherence to dosage regimes. 3. Scrutiny of the above paediatric cases associated with chronic paracetamol poisoning suggests that the margin of safety of frequent therapeutic doses of paracetamol in infants and young children to be a lot lower than previously appreciated. This review highlights the need to re‐evaluate the safety of paracetamol in the context of chronic therapy in infants and young children.

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Section: Diagnostic Nomogramssupporting

confidence: 50%

Section: Introductionmentioning

confidence: 99%

Paracetamol poisoning in children and hepatotoxicity.

Penna

Buchanan

1991

Brit J Clinical Pharma

149

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“…resistant to the hepatotoxic effects of paracetamol (Meredith et al, 1978;Rumack & Peterson, 1978;) but the mechanism is not understood, and very little is known of the sensitivity of neonates to the drug. In adults the decision to treat a patient poisoned with paracetamol depends on the plasma paracetamol concentration and Nacetylcysteine is usually given when this is above the treatment line (Prestcott et al, 1979).…”

Section: Resultsmentioning

confidence: 99%

“…Of enquiries received by the National Poisons Information Service regarding paracetamol overdose 20% of cases involved children 13 years old or less (Meredith et al, 1981). It is generally accepted that young children (less than 10 years old) have a degree of resistance to the hepatotoxic effects of paracetamol (Meredith et al, 1978;Rumack & Peterson, 1978;, although the basis to this resistance has not been fully established (Peterson & Rumack, 1978). There is thus a therapeutic dilemma when considering the treatment of paracetamol overdosage in the very young.…”

Section: Introductionmentioning

confidence: 99%

Paracetamol metabolites in the neonate following maternal overdose.

Roberts¹,

Robinson²,

Mughal³

et al. 1984

Brit J Clinical Pharma

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A case of paracetamol overdose in a 36 week pregnant woman is described. The baby was delivered by Caesarian section 6 h after the overdose. The mother but not the baby was treated with N‐acetylcysteine and neither suffered liver damage. The plasma paracetamol half‐life was prolonged to 10 h in the neonate compared to 2.5 h in the mother and was unaffected by a two volume exchange transfusion. The pattern of urinary metabolites in the neonate was similar to that observed in the mother, but there was a marked delay in the time taken to reach peak plasma concentrations of metabolites. This is consistent with a very slow biotransformation of the drug and may explain the relative resistance of very young children to the hepatotoxicity of paracetamol. There was no evidence of limited or decreasing capacity in sulphate conjugation nor was sulphation the major metabolic pathway. In retrospect both the obstetrical intervention and the exchange transfusion were unnecessary.

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“…Although it is safe, efficacious and well-established, its ubiquitous presence in the house and easy availability makes it a substance with high potential for harm, both accidentally and non-accidentally [5]. In fact, paracetamol is one of the most commonly implicated substances for poisoning in both children and adults [6]. In children under the age of 5 years acute paracetamol toxicity is usually due to accidental ingestion.…”

Section: Discussionmentioning

confidence: 99%

Lethal Acetaminophen Poisoning Related to Error Prescription: Medico Legal Implications - About a Case Report

Amine¹

2017

Neonat Pediatr Med

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Acetaminophen poisoning, leading to death, is a serious and dramatic accident for even the family and pediatricians. Prescribing error can engage the physician's responsibility. In this context, we report a case of lethal acetaminophen poisoning related to error prescription, occurred in an infant with underlying liver disease and we discuss its medico-legal implications. He was an 11 month-old boy, without medical history, who was presented to his pediatrician for a nasopharyngitis with gastroenteritis of three days duration. The prescription involved two drug forms of Acetaminophen. The total prescribed dose was 270 mg/kg/day. The death occurred after two days. A blood analysis tested before his death showed a major hepatic cytolysis with toxic level of acetaminophen. Forensic autopsy has been ordered. At dissection, the liver was palish and hemorrhagic. Toxicological screening showed a high level of acetaminophen (79 mg/l). Histological examination concluded to diffuse microvacuolar steatosis. This case report highlights the risk of hepatotoxicity of acetaminophen. This complication is even more serious if the child already has a congenital, unknown liver disease. The physician and the pharmacist's liability, in this case, would be incurred even with partial causal link.

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Paracetamol poisoning in children.

Cited by 36 publications

References 1 publication

Paracetamol poisoning in children and hepatotoxicity.

Paracetamol poisoning in children and hepatotoxicity.

Paracetamol metabolites in the neonate following maternal overdose.

Lethal Acetaminophen Poisoning Related to Error Prescription: Medico Legal Implications - About a Case Report

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