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Therapeutic misadventures with acetaminophen: hepatoxicity after multiple doses in children

J E Heubi1, M B Barbacci, H J Zimmerman

  • 1Division of Pediatric Gastroenterology and Nutrition, Children's Hospital Medical Center, Cincinnati, Ohio 45229-3039, USA.

The Journal of Pediatrics
|February 21, 1998
PubMed

Insights

Acetaminophen overdose in children can cause severe liver damage (hepatotoxicity). Parents should avoid exceeding recommended doses, especially with adult formulations, to prevent serious outcomes.

Area of Science:

  • Pediatric Toxicology
  • Hepatology
  • Pharmacovigilance

Background:

  • Acetaminophen (paracetamol) is a common over-the-counter medication for pain and fever.
  • Concerns exist regarding its safety in pediatric populations, particularly with non-standard dosing.
  • Hepatotoxicity is a known risk associated with acetaminophen overdose.

Purpose of the Study:

  • To investigate the incidence and characteristics of acetaminophen-induced hepatotoxicity in children following multiple overdoses.
  • To compare liver enzyme levels in children with acetaminophen overdose versus those with other causes of hepatic failure.

Main Methods:

  • Compilation of case reports from published literature, FDA adverse event reporting system, and a children's hospital.
  • Analysis of patient demographics, dosage, duration of acetaminophen intake, and clinical outcomes.
  • Measurement and comparison of serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels.

Main Results:

  • Forty-seven children ingested 60-420 mg/kg/day of acetaminophen for up to 42 days; 52% received adult formulations.
  • Mean peak AST and ALT levels were significantly higher in acetaminophen-overdosed children compared to controls (p < 0.001).
  • Twenty-two of 30 patients had acetaminophen levels above the toxic range for acute ingestion; 55% of patients died or required liver transplantation.

Conclusions:

  • Multiple overdoses of acetaminophen, particularly adult formulations, pose a significant risk of severe hepatotoxicity in children.
  • Elevated liver enzymes indicate substantial liver injury in pediatric acetaminophen overdose cases.
  • Healthcare providers and parents must be vigilant about weight-based dosing recommendations to prevent acetaminophen-induced liver failure in children.

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