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Age as a variable in acetaminophen overdose
Insights
Accidental acetaminophen ingestion in young children rarely causes toxicity. Even with toxic plasma levels, acetylcysteine treatment showed minor liver function abnormalities in children.
Area of Science:
- Pediatrics
- Toxicology
- Pharmacology
Background:
- Acetaminophen overdose in children can lead to severe hepatotoxicity.
- Accidental ingestions are common in young children, but severe outcomes are infrequent.
Purpose of the Study:
- To evaluate acetaminophen toxicity and the efficacy of acetylcysteine in pediatric ingestions.
- To assess liver function and plasma acetaminophen levels in children following accidental overdose.
Main Methods:
- Retrospective review of 17 pediatric acetaminophen ingestions.
- Measurement of plasma acetaminophen levels and liver function tests.
- Treatment with acetylcysteine in cases with toxic plasma levels.
Main Results:
- Five children had toxic plasma acetaminophen levels and received acetylcysteine treatment.
- No severe liver damage was observed in treated children, regardless of treatment delay (up to 20 hours).
- Minor liver function abnormalities were transient in treated patients.
Conclusions:
- Acetaminophen overdose in young children is often associated with less severe outcomes than in adults.
- Acetylcysteine is effective in preventing severe hepatotoxicity in pediatric acetaminophen ingestions, even when initiated late.
Abstract:
More than 300 accidental ingestions of acetaminophen products in children 6 years of age and younger have been reported to the Rocky Mountain Poison Center, Denver, during September 1974 to September 1979. Few of these have resulted in toxic reactions, based on clinical examination of the children. This report documents 17 childhood ingestions of acetaminophen in which plasma levels of the substance were measured and liver function was evaluated. Thirteen of these cases occurred as a result of accidental ingestion by children 6 years of age or younger; five of these children had documented plasma levels that were in the toxic range of an adult nomogram and were treated with acetylcysteine. Only minor abnormalities in liver function were observed in the treated children, even when therapy was instituted as late as 20 hours after ingestion.