Paracetamol poisoning in adolescents in an Australian setting: not quite adults.
OBJECTIVE
To describe and compare the characteristics of paracetamol poisoning in adolescent and adult patients.


METHODS
Descriptive retrospective case series of adolescent (12-17 years) and adult (>18 years) patients presenting to a metropolitan hospital network ED, diagnosed with paracetamol poisoning from October 2009 to September 2013.


RESULTS
There were 220 adolescent (median age 16 years, 47% treated with acetylcysteine [NAC]) and 647 adult presentations (median age 27 years, 42% treated with NAC) for paracetamol poisoning in the study period. Adolescent patients were more frequently women (89% vs 76%; odds ratio [OR] 2.4; 95% confidence interval [CI] 1.5-3.8) and ingested similar amounts of paracetamol (18 g) when requiring NAC treatment. Adolescents were more likely to ingest paracetamol as a single agent (53% vs 34%; OR 2.2; 95% CI 1.6-3.0) and less likely to ingest compound paracetamol products than adults (18% vs 29%; OR 0.54; 95% CI 0.36-0.79). Adolescents were less likely to report accidental supratherapeutic ingestion of paracetamol (0.02% vs 10%; OR 0.23; 95% CI 0.09-0.58), or co-ingestion of prescription medications (25% vs 43%; OR 0.4; 95% CI 0.31-0.62). Adolescents had more frequent histamine release reactions to NAC than adults (17% vs 8%; OR 2.3; 95% CI 1.2-4.5). No cases required liver transplantation or resulted in death.


CONCLUSIONS
Adolescents ingested comparable amounts of paracetamol to adults, when presenting with deliberate self-poisoning. However, there were significant differences in co-ingested medications and the reason for ingestion of paracetamol. Histamine reactions to NAC were more common in adolescents; however, most were mild. Overall, outcome was favourable in both cohorts.
Monash Health Clinical Toxicology and Addiction Medicine Service, Monash Emergency Medicine Program, Monash Dandenong Hospital, Monash Health, Melbourne, Victoria, Australia; School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.
Andis
A
Graudins
D000082:Acetaminophen / Q000506:poisoning*; D000293:Adolescent; D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology; D018712:Analgesics, Non-Narcotic / Q000506:poisoning*; D062787:Drug Overdose; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D055815:Young Adult
D018712:Analgesics, Non-Narcotic; D000082:Acetaminophen
acetaminophen; acetylcysteine; adolescent; overdose; paracetamol; poisoning