PediatricsProspective evaluation of mild to moderate pediatric acetaminophen exposures☆
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INTRODUCTION
Acetaminophen is one of the most commonly ingested medications in the United States. Although generally considered to be a safe drug, acetaminophen poisoning can result in significant morbidity and mortality, including fulminant hepatic necrosis, acute renal failure, and liver transplantation.1, 2, 3, 4, 5 Millions of dollars in health care expenditures are spent annually to rule out and treat acetaminophen poisoning.6, 7, 8 During 1997, the American Association of Poison Control Centers
MATERIALS AND METHODS
We performed a prospective, observational study of telephone calls involving acute mild to moderate pediatric acetaminophen or acetaminophen-containing products presenting to a regional PCC, from March 1, 1996, to March 31, 1998. All children who had not yet reached their seventh birthday, with acute maximum possible acetaminophen ingestions of up to 200 mg/kg, were entered into the study protocol. Patients were excluded from the study if any gastrointestinal decontamination procedures had been
RESULTS
During the study period, the PCC received 89,679 calls regarding human exposures. Of these, 1,039 cases (520 boys and 519 girls) were enrolled in the study; average patient age was 2.3 years (Figure).Data for 2 cases were incomplete. Estimated exposures ranged from 20 to 200 mg/kg; 236 patients had exposures of
DISCUSSION
In this study, we followed 1,019 children with acute acetaminophen ingestions of up to 200 mg/kg with home monitoring alone. There were no adverse outcomes at 72-hour follow-up in this population.
Acetaminophen remains a common pediatric exposure in the United States.6, 7, 8 A number of studies have recognized that children appear to be somewhat protected from severe hepatotoxicity from acute acetaminophen ingestions.3, 9, 10, 11, 12, 13 Authors have postulated that this is partly due to the
Acknowledgements
We thank the staff of the San Diego Division of the California Poison Control System, without whom this study would not have been possible. We also acknowledge the statistical assistance of Reena Deutsch, PhD, and G. Paul Shragg, MA, of the General Clinical Research Center at the University of California, San Diego, who are supported by NIH grant M01 RR00827.
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Cited by (47)
Pediatric Acute Pain Management
2013, Practical Management of Pain: Fifth EditionPediatric acute pain management
2013, Practical Management of Pain: Fifth EditionA Review of Acetaminophen Poisoning
2012, Critical Care ClinicsCitation Excerpt :A single acute ingestion of greater than 7.5 g in an adult or 150 mg/kg in children has been considered potentially toxic, although these thresholds are probably conservative.25 Single acute ingestions of less than 200 mg/kg in young children (age <6 years) are unlikely to result in toxicity.26–28 Asymptomatic elevations of aminotransferases are sometimes seen with chronic use at the maximum recommended daily dose of 4 g.
Acute Pain Management in Children
2008, Raj's Practical Management of PainErrors in paracetamol poisoning in children aged less than 6 years old [3]
2006, Anales de PediatriaChanges in pediatric toxic dose of acetaminophen [8]
2004, American Journal of Emergency Medicine
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Address for reprints: Christy Rosa Mohler, MD, UCSD Medical Center, Department of Emergency Medicine, 200 West Arbor Drive, MCH 8676, San Diego, CA 92103; fax 619-543-3115; E-mail [email protected] .