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Hepatotoxicity induced by acute and chronic paracetamol overdose in children: Where do we stand?

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Abstract

Background

There are few data on hepatotoxicity induced by acute or chronic paracetamol poisoning in the pediatric population. Paracetamol poisoning data can reveal the weaknesses of paracetamol poisoning management guidelines.

Methods

We retrospectively studied the patients of less than 18 years old with measurable paracetamol levels, who were brought to the emergency department (ED) of La Paz University Hospital, Madrid, Spain, for suspected paracetamol overdoses between 2005 and 2010.

Results

Ninety-two patients with suspected paracetamol poisoning were identified. In 2007, the incidence of paracetamol poisoning in the pediatric population was 0.8 [Poisson-95% confidence interval (CI): 0.03-3.69] per 10 000 inhabitants aged less than 18 years. The incidence in the same year was 1.53 (Poisson-95% CI: 0.24-5.57) per 10 000 patients in the pediatric ED. The most common cause of poisoning was attempted suicide (47.8%) in teenagers with a median age of 15 years, followed by accidental poisoning (42.2%) in babies with a median age of 2.65 years. Difference was seen in the frequency of hepatotoxicity between acute and chronic poisoning cases. Only 1 of 49 patients with acute poisoning showed hepatotoxicity [acute liver failure (ALF)], whereas 7 of 8 patients with chronic poisoning showed hepatotoxicity (3 cases of ALF). The average time to medical care was 6.83 hours for acute poisoning and 52.3 hours for chronic poisoning (P<0.001).

Conclusions

Chronic paracetamol poisoning is a potential risk factor for hepatotoxicity and acute liver failure. Delays in seeking medical help might be a contributing factor. Clinicians should have a higher index of clinical suspicion for this entity.

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Acknowledgements

We are grateful to ServingMed.com for the corrections to the English grammar and the academic style of the manuscript.

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Authors and Affiliations

  1. Department of Clinical Pharmacology, Hospital Universitario La Paz, IdiPAZ, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain

    Hoi Yan Tong, Nicolás Medrano, Alberto Manuel Borobia & Antonio José Carcas

  2. Pediatric Emergency Department, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain

    José Antonio Ruiz, Julia Martín & Santos García

  3. General Emergency Department, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain

    Ana María Martínez & Manuel Quintana

  4. Department of Clinical Pharmacology, Hospital Universitario La Paz, IdiPAZ, School of Medicine, Universidad Autónoma de Madrid, Madrid, Paseo de la Castellana, 261, 28046, Spain

    Elena Ramírez

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  1. Hoi Yan Tong
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  2. Nicolás Medrano
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Correspondence to Elena Ramírez.

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Tong, H.Y., Medrano, N., Borobia, A.M. et al. Hepatotoxicity induced by acute and chronic paracetamol overdose in children: Where do we stand?. World J Pediatr 13, 76–83 (2017). https://doi.org/10.1007/s12519-016-0046-6

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  • DOI: https://doi.org/10.1007/s12519-016-0046-6

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