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A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings
06:59

A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings

Published on: November 9, 2016

Intravenous paracetamol overdose: two case reports and a change to national treatment guidelines

Richard M Beringer1, John P Thompson, Sarah Parry

  • 1Department of Paediatric Anaesthesia and Acute Pain Management, Bristol Royal Hospital for Children, Bristol, UK. richard.beringer@uhbristol.nhs.uk

Archives of Disease in Childhood
|December 4, 2010
PubMed

Insights

Accidental 10-fold overdoses of intravenous paracetamol in children can cause liver damage. Prompt treatment with N-acetylcysteine can prevent hepatic impairment following paracetamol overdose.

Area of Science:

  • Pediatric Pharmacology
  • Clinical Toxicology
  • Pharmacovigilance

Background:

  • Intravenous paracetamol is used for pain and fever management in children.
  • Therapeutic errors, including significant overdoses, can occur during pediatric medication administration.
  • Accurate dosing is critical, especially with concentrated intravenous formulations.

Observation:

  • Two cases of accidental 10-fold intravenous paracetamol overdose in infants are detailed.
  • Case 1: A 5-month-old received 90 mg/kg without antidote, developing hepatic impairment.
  • Case 2: A 6-month-old received 75 mg/kg, treated with N-acetylcysteine, and remained well.

Findings:

  • Intravenous paracetamol overdose poses a risk of hepatic impairment in children.
  • Early administration of N-acetylcysteine is crucial for mitigating paracetamol-induced liver injury.
  • Standard nomograms for oral overdose may require cautious application for intravenous scenarios.

Implications:

  • Healthcare providers must exercise extreme caution when prescribing intravenous paracetamol to pediatric patients.
  • Clinical guidelines should be updated to address intravenous paracetamol overdose management.
  • Consultation with poison control centers is recommended for significant paracetamol overdoses in children.

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