Intravenous paracetamol overdose: two case reports and a change to national treatment guidelines.
Two cases of 10-fold accidental overdose with intravenous paracetamol are presented. Case 1: A 5-month-old child with intussusception received 90 mg/kg intravenous paracetamol over an 8 h period. She was not initially treated with an antidote and developed hepatic impairment. Case 2: A 6-month-old child received a single dose of 75 mg/kg intravenous paracetamol. The child was treated with N-acetylcysteine and remained well without hepatic impairment. Therapeutic errors such as 10-fold overdosing are relatively common in children. Case 1 demonstrates that intravenous paracetamol is a potentially dangerous drug. This should be taken into consideration when prescribing the intravenous formulation. The concentration-time nomogram used following oral paracetamol overdose should be used with caution following intravenous overdose. Significant overdose should be discussed with the National Poisons Information Service whose guidance suggests intervention with antidote following an overdose above 60 mg/kg.
Department of Paediatric Anaesthesia and Acute Pain Management, Bristol Royal Hospital for Children, Bristol, UK. richard.beringer@uhbristol.nhs.uk
Richard M
RM
Beringer
John P
JP
Thompson
Sarah
S
Parry
Peter A
PA
Stoddart
D000082:Acetaminophen / Q000008:administration & dosage / Q000506:poisoning*; D000111:Acetylcysteine / Q000627:therapeutic use; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage / Q000506:poisoning*; D000931:Antidotes / Q000627:therapeutic use; D056486:Chemical and Drug Induced Liver Injury / Q000188:drug therapy / Q000209:etiology*; D062787:Drug Overdose; D005260:Female; D006801:Humans; D007223:Infant; D007275:Injections, Intravenous; D008297:Male; D017410:Practice Guidelines as Topic; D006113:United Kingdom
D018712:Analgesics, Non-Narcotic; D000931:Antidotes; D000082:Acetaminophen; D000111:Acetylcysteine