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Fulminant hepatic failure and paracetamol overuse with therapeutic intent in febrile children

S Sri Ranganathan1, M G Sathiadas, S Sumanasena

  • 1Department of Pharmacology, Faculty of Medicine, University of Colombo, Sri Lanka.

Indian Journal of Pediatrics
|November 9, 2006
PubMed

Insights

Overusing paracetamol (acetaminophen) with therapeutic intent in children with fever increases the risk of developing fulminant hepatic failure. This overuse leads to significantly higher paracetamol levels and severe liver injury.

Area of Science:

  • Pediatric Hepatology
  • Clinical Pharmacology
  • Toxicology

Background:

  • Fulminant hepatic failure (FHF) is a rare but severe complication in children.
  • Paracetamol (acetaminophen) is a common antipyretic used in febrile children.
  • Understanding risk factors for FHF is crucial for patient safety.

Purpose of the Study:

  • To investigate the association between paracetamol overuse and FHF in children treated for febrile illnesses.
  • To quantify paracetamol exposure in children who developed FHF.

Main Methods:

  • A case-control study comparing 25 children with FHF to 33 age-matched controls.
  • Assessed paracetamol ingestion history and measured serum paracetamol levels.
  • Evaluated clinical presentation including hepatic encephalopathy grading and liver enzyme levels.

Main Results:

  • All FHF cases consumed supra-therapeutic paracetamol doses (mean 145 mg/kg/day), unlike controls.
  • Mean serum paracetamol levels were significantly higher in cases (26.84 mg/dL) vs. controls (0.051 mg/dL).
  • FHF cases showed higher rates of hepatomegaly, jaundice, and elevated alanine aminotransferase (ALT).

Conclusions:

  • Supra-therapeutic paracetamol dosing is a significant risk factor for FHF in febrile children.
  • This risk is associated with acute viral-like febrile illnesses.
  • Careful monitoring of paracetamol dosage is essential in pediatric fever management.
Abstract

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