Related Experiment Video

Updated: Jun 5, 2026

Inducing Acute Liver Injury in Rats via Carbon Tetrachloride (CCl4) Exposure Through an Orogastric Tube
06:12

Inducing Acute Liver Injury in Rats via Carbon Tetrachloride (CCl4) Exposure Through an Orogastric Tube

Published on: April 28, 2020

[Intentional paracetamol intoxication in children]

Lauke A Bisschops1, Wim A H Bisschops, Maurice P Vroegop

  • 1UMC St Radboud, Nijmegen, the Netherlands. l.bisschops@seh.umcn.nl

Nederlands Tijdschrift Voor Geneeskunde
|January 26, 2011
PubMed

Insights

Acetaminophen (paracetamol) overdose is common, but severe liver damage is rare, especially in children. Acetylcysteine is the key antidote, guided by the Rumack-Matthew nomogram, even in pediatric cases.

Area of Science:

  • Toxicology
  • Pediatrics
  • Emergency Medicine

Background:

  • Acetaminophen (paracetamol) is a widely available medication, leading to frequent auto-intoxication cases.
  • While most acetaminophen overdoses are asymptomatic, a subset can develop severe liver damage or fatalities.
  • Children exhibit a lower susceptibility to acetaminophen toxicity complications compared to adults.

Purpose of the Study:

  • To review the management of acetaminophen (paracetamol) auto-intoxication.
  • To discuss the role of acetylcysteine antidote and the applicability of the Rumack-Matthew nomogram in pediatric cases.
  • To outline current recommendations for gastric decontamination and supportive care.

Main Methods:

  • Literature review on acetaminophen toxicity and its management.
  • Analysis of the Rumack-Matthew nomogram's validation and use in pediatric populations.
  • Synthesis of guidelines regarding gastric lavage, activated charcoal, and antidote administration.

Main Results:

  • Acetylcysteine is the cornerstone treatment for acetaminophen overdose.
  • The Rumack-Matthew nomogram, though validated in adults, is commonly applied to children.
  • Gastric lavage is generally not recommended; activated charcoal is effective if given within 1 hour to cooperative patients.

Conclusions:

  • Effective management of acetaminophen overdose requires a multidisciplinary approach.
  • Collaboration between emergency physicians, pediatricians/internists, pharmacists, and child psychiatrists is crucial.
  • While severe complications are infrequent, prompt and appropriate treatment, including acetylcysteine, is vital for preventing adverse outcomes.

More Related Videos

Handheld Metal Detector Screening for Metallic Foreign Body Ingestion in Children04:55

Handheld Metal Detector Screening for Metallic Foreign Body Ingestion in Children

Published on: September 11, 2018

Related Concept Videos

Pharmaceutical Poisoning: Potential Scenarios01:26

Pharmaceutical Poisoning: Potential Scenarios

Pharmaceutical poisoning can occur through various channels, impacting an estimated 2 million hospitalized patients in the U.S. annually with serious adverse drug responses. These scenarios encompass both therapeutic uses, such as drug toxicity, where even standard dosages can lead to severe central nervous system depression, and non-therapeutic exposures, including accidental ingestion by children, and environmental and occupational exposures.Unintentional poisonings often involve exploratory...
Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption01:23

Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption

Understanding the physiological differences in the pediatric population is crucial for effective pharmacotherapy. Neonates, infants, and children exhibit significant variations in gastric pH, gastric emptying time, intestinal transit time, and biliary function. These variations profoundly affect oral drug absorption, necessitating a nuanced approach to pediatric dosing.Neonates present with a unique physiological profile, having a gastric pH greater than 4 and faster and more irregular gastric...
Prevention of Further Absorption of Poison01:14

Prevention of Further Absorption of Poison

In cases of acute poisoning, the primary objective is to prevent further absorption of the toxic substance into the body. Immediate interventions using various decontamination techniques targeting the gastrointestinal (GI) tract can achieve this. Decontamination is crucial to prevent poison from entering the systemic circulation, which involves washing affected areas with water and mild soap and removing contaminated clothing. Once external decontamination is done, attention must be turned to...
Pharmacokinetics in Pediatric Patients: Drug Metabolism01:24

Pharmacokinetics in Pediatric Patients: Drug Metabolism

In pediatric care, understanding the nuances of hepatic drug metabolism is crucial, as it significantly differs from that of adults. This divergence is primarily due to the developmental stage of drug-metabolizing enzymes, which affects how medications are processed in the body. In neonates, for instance, the activity of Phase I enzymes—critical for the initial breakdown of drugs—is markedly reduced, functioning at just 20–40% of the levels seen in adults. This reduction poses a challenge in...
Anticholinesterase Agents: Poisoning and Treatment01:26

Anticholinesterase Agents: Poisoning and Treatment

Anticholinesterases, also known as cholinesterase inhibitors, work by blocking the breakdown of acetylcholine, leading to its accumulation in the synaptic cleft. This accumulation indirectly enhances both muscarinic and nicotinic actions. These agents are classified as reversible or irreversible based on their mechanism of action.     
Irreversible agents form a strong bond with the cholinesterase enzyme, making it inactive. The breakdown of the phosphorylated enzyme is slower than the...
Pharmaceutical Poisoning: Treatment Strategies01:26

Pharmaceutical Poisoning: Treatment Strategies

Treatment strategies for poisoning are a critical aspect of emergency medicine, focusing on preventing the absorption of toxins and enhancing their elimination. When a poisoning incident occurs, the first response is to halt exposure and decontaminate the patient, particularly through gastrointestinal (GI) methods if the poison was ingested.Gastrointestinal Decontamination Techniques:Activated charcoal is the cornerstone of GI decontamination. It works through adsorption, binding the toxin to...