Fulminant hepatic failure and paracetamol overuse with therapeutic intent in febrile children.
OBJECTIVE
To evaluate the risk of fulminant hepatic failure in relation to paracetamol overuse with therapeutic intent in febrile children.


METHODS
It was a case control study. Paracetamol ingestion for the current febrile illness was compared between 25 cases of fulminant hepatic failure and 33 hospital age matched controls.


RESULTS
Supra-therapeutic doses of paracetamol (mean 145 mg/kg/day) were consumed by all 25 cases compared to none in the control group. Mean paracetamol level in the cases and controls were, respectively, 26.84 mg /dl and 0.051 mg /dl (p< 0.001). The mean duration of paracetamol intake prior to admission in cases was 3. 45 days compared to 1.85 days in the control group. Nineteen, 5 and 3 were, respectively, graded as hepatic encephalopathy grade 1, 2 and 3. All six patients in grade 2 and 3 had hepatomegaly compared to 78% in the grade 1. Four had jaundice and all were in grade 2 or 3. Mean alanine aminotransferase was 2781 U/L None of the randomly selected cases (6) had serological evidence of Hepatitis A, Hepatitis B or Dengue. Three cases died.


CONCLUSIONS
Exposure to multiple supratherapeutic doses of paracetamol is a risk factor to develop fulminant hepatic failure in children with an acute viral like febrile illness.
Ranganathan
S Sri
SS
Department of Pharmacology, Faculty of Medicine, University of Colombo, Sri Lanka.
Sathiadas
M G
MG
Sumanasena
S
S
Fernandopulle
M
M
Lamabadusuriya
S P
SP
Fernandopulle
B M R
BM
D000082:Acetaminophen / Q000506:poisoning*; D018712:Analgesics, Non-Narcotic / Q000506:poisoning*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D062787:Drug Overdose; D005260:Female; D005334:Fever / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D007223:Infant; D017114:Liver Failure, Acute / Q000139:chemically induced*; D008297:Male; D012307:Risk Factors; D014777:Virus Diseases / Q000150:complications
D018712:Analgesics, Non-Narcotic; D000082:Acetaminophen