title: Fulminant hepatic failure and paracetamol overuse with therapeutic intent in febrile children.
abstract: 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.
authors.affiliation: Department of Pharmacology, Faculty of Medicine, University of Colombo, Sri Lanka.
authors.forename: S Sri
authors.initials: SS
authors.lastname: Ranganathan
authors.forename: M G
authors.initials: MG
authors.lastname: Sathiadas
authors.forename: S
authors.initials: S
authors.lastname: Sumanasena
authors.forename: M
authors.initials: M
authors.lastname: Fernandopulle
authors.forename: S P
authors.initials: SP
authors.lastname: Lamabadusuriya
authors.forename: B M R
authors.initials: BM
authors.lastname: Fernandopulle
mesh_terms: 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
chemical_list: D018712:Analgesics, Non-Narcotic; D000082:Acetaminophen