Abstract
Objective:To evaluate the demographic and clinical features associated with acetaminophen overdose and to identify the clinical use of IV (intravenous) N- Acetylcysteine (NAC) treatment in children.Methods:This prospective study was conducted in Kanuni Sultan Suleyman Training and Research Hospital between August 2016 and August 2017. A total of 59 patients with overdose acetaminophen ingestion were included in this study. The toxic dose for acute acetaminophen intake was defined as greater than 150 mg/kg. Rumack-Matthew nomogram was used to evaluate the risk of acute intoxication and to determine the decision of using antidote.Results:The mean age of the patients was 8.5±6.4 y and 34 of them (58%) were female. The mean time from ingestion to admission was 4.3±4.7 h. The mean ingested acetaminophen dose was 142.1±80 mg/kg. Twenty four patients (41%) received NAC and there were significant differences in terms of acetaminophen dose, creatinine and INR between antidote and decontamination therapy groups at admission time (p= 0.00, p= 0.03, p= 0.02, respectively). The complication due to antidote therapy was observed in only 1 patient.Conclusions:This study confirms that the side effects due to IV NAC therapy are uncommon and it is generally well tolerated in children.
Highlights
Acetaminophen is commonly used in children as an analgesic and antipyretic
137 patients who presented for analgesics/antipyretics overdose in our hospital and we found that 59 (43%) of them ingested the drugs containing acetaminophen
When the child age group is evaluated, analgesic intoxication is third after the cosmetics and cleaning substances for younger than 5 years old children according to the 2014 annual report of the American Association of Poison Control Centers
Summary
Acetaminophen is commonly used in children as an analgesic and antipyretic. its’ safety was well established, it is one of the common cause of drug poisoning. 2. Abdurrahman Avar Ozdemir Department of Pediatrics, Medicine Hospital, Biruni University, Turkey. Approximately 5-10% of the drug is metabolized by Cytochrome P450 (CYP450) to a toxic metabolite, N-acetyl-pbenzoquinoneimine (NAPQI). When acetaminophen is used at the recommended doses, NAPQI is eliminated by conjugation with glutathione. If it is used overdose, glutathione stores are depleted and the clearance of NAPQI is reduced. As a result, this toxic metabolite accumulates and causes hepatocellular injury.[2] Management of acetaminophen overdose includes; gastric lavage, using of activated charcoal and N-Acetylcysteine (NAC) as an antidote.[1,2,3].
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