Acetaminophen and Aspirin Overdose in an Extremely Preterm Neonate

Abstract

IntroductionAcetaminophen (N‐acetyl‐p‐aminophenol; APAP) is a widely available over‐the‐counter analgesic which is considered safe at standard dosing, but can produce significant drug‐induced liver injury and acute liver failure when taken in excess. Aspirin (acetylsalicylic acid) is a commonly used non‐steroidal anti‐inflammatory and anti‐platelet medication, which can produce significant respiratory and metabolic derangements when taken in large amounts. Accidental and intentional overdoses of these two medications are often encountered in children and adults and have widely accepted treatment protocols. There are currently no reported cases describing the presentation and treatment of a combined acetaminophen and aspirin overdose in a premature neonate.Case ReportThis case describes a premature infant born at 26 weeks gestation one day after her mother is hospitalized for management of an overdose of acetaminophen and aspirin. The mother had significantly elevated blood levels of both drugs, and underwent treatment with N‐acetylcysteine (NAC) and sodium bicarbonate. Acetaminophen and aspirin are both known to cross the placenta and can cause neonatal hepatotoxicity and coagulopathy respectively. NAC acts as an antidote to acetaminophen toxicity and also crosses the placenta, so administration is recommended to treat acetaminophen overdose in pregnancy. In this case, the baby was delivered before the treatment course was completed and subsequently showed signs of liver injury. The infant had laboratory results showing elevated acetaminophen and aspirin levels, metabolic acidosis, and prolonged PT, PTT, and INR. The neonate had resolution of her metabolic acidosis with administration of fluids containing sodium acetate. It was recommended by our neonatal pharmacist and toxicology experts to administer NAC, but the standard dosing regimen and concentration of NAC would provide an unsafe excess of fluid. This case report describes our novel treatment protocol that was formulated to provide this extremely low birth weight neonate with appropriate weight‐based doses of NAC. She clinically improved and did well while in the neonatal intensive care unit, with no further consequences of the overdose.ConclusionThis is the first case report describing the presentation and unique management strategies of an acetaminophen and aspirin overdose in an extremely premature baby.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.