title: Paracetamol-associated acute liver failure in Australian and New Zealand children: high rate of medication errors.
abstract: BACKGROUND
  In children, paracetamol overdose due to deliberate self-poisoning, accidental exposure or medication errors can lead to paediatric acute liver failure and death. In Australia and New Zealand, the nature of ingestion and outcomes of paracetamol-associated paediatric acute liver failure have not been described.
  
  
  OBJECTIVE
  To describe the nature and outcomes of paracetamol-associated paediatric acute liver failure.
  
  
  METHODS
  Retrospective analysis of paracetamol-associated paediatric acute liver failure cases presenting 2002-2012.
  
  
  METHODS
  New Zealand and Queensland Paediatric Liver Transplant Services.
  
  
  RESULTS
  14 of 54 cases of paediatric acute liver failure were attributed to paracetamol, the majority were secondary to medication errors. 12 of the 14 children were under the age of 5 years. Seven children received doses in excess of 120 mg/kg/day. Many of the other children received either a double dose, too frequent administration, coadministration of other medicines containing paracetamol or regular paracetamol for up to 24 days. Three children underwent transplant. One of these and one other child died.
  
  
  CONCLUSIONS
  In Australia and New Zealand, paracetamol overdose secondary to medication errors is the leading cause of paediatric acute liver failure. A review of regional safety practices surrounding paracetamol use in children is indicated.
authors.affiliation: Department of Paediatric Gastroenterology, Hepatology and Nutrition, Starship Children's Hospital, Auckland, New Zealand.
authors.forename: J
authors.initials: J
authors.lastname: Rajanayagam
authors.affiliation: Department of Paediatric Gastroenterology, Hepatology and Nutrition, Starship Children's Hospital, Auckland, New Zealand.
authors.forename: J R
authors.initials: JR
authors.lastname: Bishop
authors.affiliation: Department of Paediatric Gastroenterology, Hepatology and Nutrition, Royal Children's Hospital, Brisbane, Australia.
authors.forename: P J
authors.initials: PJ
authors.lastname: Lewindon
authors.affiliation: Department of Paediatric Gastroenterology, Hepatology and Nutrition, Starship Children's Hospital, Auckland, New Zealand.
authors.forename: Helen M
authors.initials: HM
authors.lastname: Evans
mesh_terms: D000082:Acetaminophen / Q000506:poisoning*; D000293:Adolescent; D018712:Analgesics, Non-Narcotic / Q000506:poisoning*; D001315:Australia / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D017114:Liver Failure, Acute / Q000139:chemically induced*; D008297:Male; D008508:Medication Errors / Q000706:statistics & numerical data*; D009520:New Zealand / Q000453:epidemiology; D012189:Retrospective Studies
chemical_list: D018712:Analgesics, Non-Narcotic; D000082:Acetaminophen
keywords: Analgesia; Drug Abuse; Hepatology; Mortality; Toxicology