Related Experiment Videos
Pediatric acetaminophen overdose: risk factors associated with hepatocellular injury
S W Alander1, M D Dowd, S L Bratton
1Department of Pediatrics, Children's Mercy Hospital, Kansas City, Mo 64108, USA. salander@cmh.edu
Insights
Pediatric acetaminophen overdose can lead to liver injury, especially in older children with intentional ingestions presenting after 24 hours. Early recognition is key to preventing severe hepatotoxic effects.
Area of Science:
- Pediatric Toxicology
- Hepatology
- Clinical Pharmacology
Background:
- Acetaminophen overdose is a common cause of acute liver injury in children.
- Understanding risk factors for hepatocellular injury is crucial for timely intervention.
Purpose of the Study:
- To characterize demographic and clinical factors associated with pediatric acetaminophen overdose.
- To identify risk factors for developing hepatocellular injury following acetaminophen overdose.
Main Methods:
- Retrospective chart review of 322 pediatric patients across two children's hospitals over 10 years (1988-1997).
- Hepatocellular injury defined by elevated aminotransferase levels; severe hepatotoxic effect by encephalopathy/coagulopathy.
- Analysis of intentional vs. unintentional ingestions, dosing errors, and clinical presentation times.
Main Results:
- Hepatocellular injury occurred in 27 patients (8.4%), with severe effects in 4 and 1 death.
- Risk factors for injury included presentation >24 hours post-ingestion (OR 335.0), age 10-17 years (OR 36.9), intentional overdose (OR 37.2), dose >150 mg/kg (OR 17.9), and white race (OR 2.8).
- Intentional overdoses (17.9%) and dosing errors (10.0%) had higher injury rates than unintentional ingestions (0.6%).
Conclusions:
- Acetaminophen overdose in children presents with both intentional and unintentional ingestions.
- Hepatocellular injury is significantly associated with delayed presentation, older age, intentional overdose, and higher doses.
- Clinicians should maintain a high index of suspicion for acetaminophen-induced liver injury in at-risk pediatric populations.
Objectives:
To characterize demographic and clinical factors associated with pediatric acetaminophen overdose and identify risk factors for hepatocellular injury.
Design:
Retrospective 10-year chart review.
Setting:
Two regional children's hospitals.
Materials And Methods:
Records of patients examined because of acetaminophen ingestion from January 1, 1988, through December 31, 1997, were reviewed. Hepatocellular injury was defined as elevation of serum aminotransferase levels greater than 2 times the reference values. Severe hepatotoxic effect was defined as hepatotoxic effect with evidence of encephalopathy and/or coagulopathy.
Results:
Data from 322 patients (208 girls and 114 boys, aged 1-17 years) were obtained. Ingestions were intentional in 140 patients (median age, 14 years) and unintentional in 172 (median age, 2 years). Another 10 cases represented dosing errors with therapeutic intent (median age, 3.5 years). Twenty-seven patients had hepatocellular injury; of these, 4 had severe hepatotoxic effects and 1 died. Hepatocellular injury occurred in 10.0% of the dosing error group, 17.9% of the intentional group, and 0.6% of the unintentional group. No patients underwent liver transplantation. Hepatocellular injury was associated with presentation longer than 24 hours after ingestion (odds ratio [OR], 335.0; 95% confidence interval [CI], 40.8-275.0), age 10 to 17 years (OR, 36.9; 95% CI, 4.9-275.4), intentional overdose (OR, 37.2; 95% CI, 5.0-278.2), dose greater than 150 mg/kg (OR, 17.9; 95% CI, 2.3-139.2), and white race (OR, 2.8; 95% CI, 1.1-7.2).
Conclusions:
Intentional and unintentional acetaminophen overdoses occurred with similar frequency. Therapeutic misadventure was relatively uncommon, as was hepatocellular injury. Practitioners should have greater suspicion of acetaminophen-associated hepatocellular injury in patients who present more than 24 hours after ingestion, older children, and those who have intentional ingestion.