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[Paracetamol poisoning in infancy]
A Claass1, M Gaude, H Schröder
1Klinik für Allgemeine Pädiatrie, Universität Kiel.
Insights
An infant experienced severe liver and kidney damage after paracetamol overdose. Despite treatment, the child has lasting developmental delays, possibly due to paracetamol poisoning.
Area of Science:
- Pediatric toxicology
- Clinical pharmacology
Background:
- An infant with alcohol embryopathy developed abnormal liver function post-surgery.
- Postoperative pain management involved paracetamol administration over 60 hours.
Observation:
- Elevated serum paracetamol levels (60 mg/l) were detected 8 hours after the last dose.
- Exchange transfusion reduced paracetamol levels, but severe encephalopathy and renal impairment emerged.
- Candida infection was noted in urine, tracheal secretions, and ascites.
Findings:
- Renal and hepatic damage were reversible with symptomatic treatment.
- The infant, now 1 year old, exhibits severe mental and motor function retardation.
- The long-term sequelae may be linked to paracetamol poisoning or clinical course complications.
Implications:
- This case highlights the potential for severe toxicity and lasting neurodevelopmental deficits from paracetamol overdose in infants.
- It underscores the importance of careful dosing and monitoring of paracetamol in pediatric patients, especially those with underlying conditions.
- Further investigation is needed to definitively attribute the observed sequelae to paracetamol toxicity versus other clinical factors.
Abstract:
An eight-week old infant with alcohol embryopathy, weighing 3,700 g, was found to have abnormal liver functions (GPT 312 U/l, Quick value 25%) after surgical repair of a stenosis of the left ureter at its origin. The hospital notes indicated that the infant had been given a total of 1.6 g paracetamol over 60 hours for postoperative restlessness and pain. The serum paracetamol level was 60 mg/l 8 hours after the last dose of the drug. Blood exchange transfusion lowered the paracetamol level to 11 mg/l within 14 hours. After the exchange transfusion further signs of poisoning, namely renal impairment and a severe encephalopathy were noted, and Candida was demonstrated in urine, tracheal secretion and ascites. The renal and hepatic damage proved reversible under symptomatic treatment. But the child, now 1 year old, is severely retarded mentally and in its motor functions. These sequelae may be a residue of the paracetamol poisoning, complications of the clinical course or a combination of the two.