Abstract

 
 
 
 Introduction: Acetaminophen (APAP) is the most widely used over-the-counter antipyretic and analgesic medicine in children. Although hepatic failure and death is rare in paediatric population, it is one of the most important and dangerous presentation of acetaminophen induced toxicity in children. There is very sparse data regarding APAP induced paediatric acute liver failure in our settings, hence this study was done to know the clinical and demographic profiles as well as outcome of children with APAP induced acute liver failure.
 Methods: This was a retrospective study done in children aged 0 - 18 years admitted with the diagnosis of acetaminophen induced acute liver failure in a tertiary paediatric intensive care unit of South India from January 2014 to December 2018. The clinical, demographic profiles and outcome of these patients were reviewed and analysed.
 Results: A total of 26 children had acetaminophen induced acute liver failure. Out of 26 patients, 53.8% were males and 46.1% were females. Among these, 24 (92.3%) survived and two (7.7%) died. The average dose of acetaminophen ingested was 168.5 mg/ kg/d. The mean serum acetaminophen level was 52.3 mg/dl. The presence of low pH, hypotension and international normalised ratio (INR) value of > 4 showed bad outcome in children with acetaminophen induced acute liver failure.
 Conclusion: Paracetamol induced acute liver failure is rare but fatal presentation in children. Children with acidosis, shock and INR value of > 4 had poor prognosis. Hence, judicious use of different preparations as well as counselling to parents regarding use of appropriate doses in children should be done while prescribing this medicine.
 
 
 
Highlights
Acetaminophen (APAP) is the most widely used over-the-counter antipyretic and analgesic medicine in children
Acetaminophen, known as N-acetyl-paraaminophenol (APAP) or paracetamol, is one of the most common over-the-counter medicine used in children
All the children aged between one month to 18 years admitted with diagnosis of APAP induced Acute Liver Failure (ALF) were included in the study
Summary
Acetaminophen (APAP) is the most widely used over-the-counter antipyretic and analgesic medicine in children. Hepatic failure and death is rare in paediatric population, it is one of the most important and dangerous presentation of acetaminophen induced toxicity in children. Acetaminophen, known as N-acetyl-paraaminophenol (APAP) or paracetamol, is one of the most common over-the-counter medicine used in children. The safety and efficacy of acetaminophen is well proven in children as compared to aspirin. The recommended dose of paracetamol in children is 10 - 15 mg/kg every four to six hours up to a maximum daily dose of 50 - 75 mg/kg.[1] In general, the risk of developing adverse effects to paracetamol is lower in children as compared to adults.[2,3] Though toxic effects of paracetamol are rare in children, its toxicity remains a concern due to wide range of usage of this drug.[4] Previous reports have suggested that 120 - 150 mg/kg of body weight may be associated with hepatoxicity.[5,6,7,8]
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