Paracetamol poisoning in children

Abstract

Paracetamol (acetaminophen) has become an antipyretic drug of choice. Due to its widespread use, toxicity secondary to overdose has increased in recent years. Children are especially vulnerable to accidental exposure due to non availability of child proof containers in India. The main clinical features of acute toxicity include anorexia, vomiting, abdominal pain, jaundice, hematuria and metabolic acidoses. Diagnosis is based on history and laboratory findings of acidosis and abnormal liver function tests. N-acetylcysteine is the specific antidote. This article reviews in detail the toxicokinetics, pathophysiology, clinical features and management of paracetamol poisoning in children.

A modified low-cost colorimetric method for paracetamol (acetaminophen) measurement in plasma

“…We have shown that in Sri Lanka and other areas of the developing world, the cost of NAC is the major cost in patients with paracetamol poisoning. 4 Previous studies have shown that the introduction of an appropriately used, accurate and cost-effective paracetamol assay was a central strategy in reducing costs and improving the standard of care of these patients. 4 Most hospitals currently have the facilities to be able to perform the colorimetric assay; therefore the additional costs of US$ 16 (31 patients) in performing paracetamol assays would result in up to four patients avoiding unnecessary treatment with NAC and a cost saving of US$ 576 (Figure 4).…”

“…Paracetamol poisoning is becoming more common in other areas of South Asia such as Nepal. 4 5 In Sri Lanka, and other areas of South Asia, laboratory facilities to determine plasma paracetamol concentrations are only available in a few private laboratories. As paracetamol assays are not widely available, risk assessment in patients presenting with paracetamol poisoning is based on the history of the dose ingested and these results in a significant proportion of individuals having unnecessary treatment with the antidote.…”

Activated Charcoal in Resource Poor Settings: Reviewing the Evidence

“…An RPS is widely defined as an environment where the use of routine antidotes (e.g., NAC for APAP overdose) is either unavailable or prohibitively expensive [2,7,13,16]. Clinical Trials in this study were defined as research studies using consenting human subjects that tests the effectiveness and safety of AC as a study intervention.…”

“…Many reports in the recent literature have investigated the use of AC internationally in resource-poor settings (RPS). An RPS is widely defined as an environment where the use of routine antidotes (e.g., NAC for acetaminophen and anti-digoxin Fab antibody fragments for Digoxin) is either unavailable or prohibitively expensive [13]. Although the rate of suicidal intent is not necessarily higher [14], self-poisoning in industrialized countries, most commonly from pharmaceuticals like acetaminophen/ paracetamol (APAP), benzodiazapenes and tricyclic antidepressants have a much lower mortality (0.5% UK) than selfpoisonings in developing countries, 10-20% mortality [14,15].…”

“…AC was once called the "ultimate antidote" (due to its safety, favorable side effect profile, low cost, and wide availability) [16][17][18][19][20], however recent literature evidence has challenged this notion. The goal of this review was to review new evidence regarding the clinical efficacy of AC in RPS, with less focus on pill ingestions [3,7,13,21], which may not be relevant for the majority of poisonings in RPS. We hypothesized a favorable risk-benefit ratio would be found given its high safety profile, theoretical mechanism, and general ease of use.…”