Paediatric exploratory ingestions of paracetamol

To review paediatric exploratory ingestions of paracetamol presenting to Christchurch Hospital Emergency Department.

A retrospective review of all paediatric patients presenting with paracetamol ingestion over a 12 month period.

During the study period there were 88 paediatric presentations for possible toxic ingestions involving paracetamol and 85 of these were exploratory self-ingestion. The male to female ratio was 43:42 and the mean age was 35 months. Paracetamol suspension was ingested in 79/85 cases and tablets in 6/85. The mean four hour plasma level was 162 mumol/L and all levels were well below the possible toxic level (1300 mumol/L). There was very poor correlation between estimated dose ingested and plasma level.

Toxicity from paediatric exploratory ingestion of paracetamol is extremely rare. To reduce the potential for poisoning, bottles and prescriptions of paracetamol should have less than a total dose of 4 g. The authors recommend that unwitnessed exploratory ingestions of paracetamol in children require no treatment if the estimated maximum ingested dose is below 140 mg/kg. Above this dose, treatment is based on the result of a plasma paracetamol level drawn four hours after ingestion. Gastrointestinal decontamination should be reserved for the rare occasions of a definite witnessed ingestion of a dose exceeding 140 mg/kg.