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Medication errors involving intravenous paracetamol in children: experience from enquiries to the National Poisons

Florence Vincent1, John Thompson2, Laurence Gray3

  • 1Royal Free London NHS Foundation Trust, London, UK florence.vincent1@nhs.net.

Archives of Disease in Childhood
|January 17, 2024
PubMed

Insights

Paediatric intravenous paracetamol overdose is a concern, with calculation errors like 10-fold overdoses being common. While most young children remain asymptomatic, improved systems can prevent these medication errors.

Area of Science:

  • Pharmacology
  • Paediatric Medicine
  • Toxicology

Background:

  • Children face higher medication error risks due to complex prescribing and administration.
  • Intravenous (IV) paracetamol overdose lacks enteral absorptive buffering, differing from ingestion overdose.
  • This study presents the first UK national data on paediatric IV paracetamol poisoning.

Purpose of the Study:

  • To analyze national UK data on paediatric intravenous paracetamol overdose.
  • To identify common error types and patient demographics in these poisoning cases.
  • To inform strategies for reducing IV paracetamol errors in children.

Main Methods:

  • Data extracted from National Poisons Information Service telephone enquiries (2008-2021).
  • Focus on children under 18 years in the UK with IV paracetamol overdose.
  • Descriptive statistical analysis of UK Poisons Information Database (UKPID) records.

Main Results:

  • 266 children involved, with 54.5% under 1 year old.
  • Common errors included 10-fold overdoses (16.9%) and concurrent oral/IV dosing (24.1%).
  • Most cases (87.1%) were asymptomatic; 42.5% received antidote acetylcysteine.

Conclusions:

  • Inadvertent IV paracetamol overdose is more frequent in young children.
  • Calculation errors, particularly 10-fold, are significant contributors.
  • While harm potential exists, most cases were asymptomatic; electronic prescribing and better communication may reduce errors.
Abstract

Keywords:
Child HealthPaediatricsPharmacologyTherapeuticsToxicology

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