These include an intentional overdose with a single dose exceeding 140 mg/kg, unintentional overdose when a child is given multiple doses of acetaminophen that exceed manufacturer recommendations, or inadvertent overdose when a child receives acetaminophen in combination with cough/cold preparations.( 2) The frequency of accidental acetaminophen overdoses causing clinically significant hepatotoxicity as described in this case is unknown. A recent study evaluating more than 28,000 children treated with acetaminophen failed to show any increased risk of acute gastrointestinal bleeding, acute renal failure, or anaphylaxis.( 1)ĭespite this enviable safety record, acetaminophen-induced hepatotoxicity can be lethal when the medicine is taken in supratherapeutic doses. Few serious adverse effects have been reported. The CommentaryĪvailable as an over-the-counter medication in the United States since 1960, acetaminophen is considered safe and effective for the management of fever and pain in children. His acetaminophen levels declined, and he was safely discharged home without further events. The patient was admitted to the hospital, given intravenous N-acetylcysteine, and his symptoms improved over the succeeding days. They gave multiple doses of 20 mL (48 mg/mL solution equaling 960 mg per dose) instead of the correct dose for their 20-kg child (6 mL = 288 mg). Laboratory evaluation indicated that acetaminophen levels and PT/INR were elevated.įurther discussion with the parents revealed that they misread the instructions about administering liquid acetaminophen. Two days later, the patient returned to the ED with continuing fever and new rigors, vomiting, lethargy, and right upper quadrant abdominal pain.
The patient was discharged with a diagnosis of viral syndrome after receiving one dose of acetaminophen in liquid form. Physical examination, vital signs, and laboratory evaluation were unremarkable. Parents brought their 5-year-old son to the emergency department (ED) with a 24-hour history of fever, cough, and frontal headache.
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