Acetaminophen overdoses in children can be life-threatening but are avoidable June
4, 2012 in
Medications Acetaminophen, a widely
available over-the-counter medication, can cause liver toxicity in children if
doses are exceeded, and more public education is needed to warn of potential
adverse effects, states an article published in CMAJ (Canadian Medical
Association Journal)."Acetaminophen overdose is a major cause of acute
liver failure and is the most common identifiable cause of acute liver failure
in children," writes Dr. Rod Lim, Department of Pediatrics, Children's
Hospital, London Health Sciences Centre, London, Ontario, with coauthors.
"Repeated supratherapeutic dosing [above the recommended dose], accidental
overdose due to error and intentional ingestion can all result in acute liver
failure and even death."The authors cite a case study of a 22-day-old baby
in which the parents misunderstood the correct dose of acetaminophen and administered
too much analgesic for a circumcision. After the procedure, when the doctor
instructed the parents to give another dose, they discovered the error. In this
case, N-acetylcysteine with dextrose was given intravenously, and the child
recovered within about 24 hours after ingesting the medication.N-acetylcysteine
is the standard treatment for liver toxicity related to an overdose of
acetaminophen and is usually successful if started within eight hours after
ingesting the drug.Medication errors involving children are a serious issue,
and dosing is complicated by the need to dose by the child's weight and convert
this dose to a volume because many medications for children are in liquid form.
A report from the US poison
control centres and the American
Academy of Pediatrics,
which analyzed 238 instances of serious medication errors in children under age
six, found that 11% of children who are given pharmaceuticals experience a
medication error such as an incorrect medication, incorrect dose or method of administering.
Acetaminophen overdose was the most common single agent responsible for a
life-threatening event, longer-term illness or death.A better approach is
needed to prevent these avoidable, and life-threatening, errors."Although
physicians and pharmacists should continue to educate parents and caregivers
regarding the medications prescribed, one-to-one communication cannot be the
sole approach to reducing errors in medication administration," write the
authors. "Error reduction on a large scale requires systems-based
interventions and prevention."
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