title: Hepatotoxicity induced by acute and chronic paracetamol overdose in children: Where do we stand?
abstract: BACKGROUND
  There are few data on hepatotoxicity induced by acute or chronic paracetamol poisoning in the pediatric population. Paracetamol poisoning data can reveal the weaknesses of paracetamol poisoning management guidelines.
  
  
  METHODS
  We retrospectively studied the patients of less than 18 years old with measurable paracetamol levels, who were brought to the emergency department (ED) of La Paz University Hospital, Madrid, Spain, for suspected paracetamol overdoses between 2005 and 2010.
  
  
  RESULTS
  Ninety-two patients with suspected paracetamol poisoning were identified. In 2007, the incidence of paracetamol poisoning in the pediatric population was 0.8 [Poisson-95% confidence interval (CI): 0.03-3.69] per 10 000 inhabitants aged less than 18 years. The incidence in the same year was 1.53 (Poisson-95% CI: 0.24-5.57) per 10 000 patients in the pediatric ED. The most common cause of poisoning was attempted suicide (47.8%) in teenagers with a median age of 15 years, followed by accidental poisoning (42.2%) in babies with a median age of 2.65 years. Difference was seen in the frequency of hepatotoxicity between acute and chronic poisoning cases. Only 1 of 49 patients with acute poisoning showed hepatotoxicity [acute liver failure (ALF)], whereas 7 of 8 patients with chronic poisoning showed hepatotoxicity (3 cases of ALF). The average time to medical care was 6.83 hours for acute poisoning and 52.3 hours for chronic poisoning (P<0.001).
  
  
  CONCLUSIONS
  Chronic paracetamol poisoning is a potential risk factor for hepatotoxicity and acute liver failure. Delays in seeking medical help might be a contributing factor. Clinicians should have a higher index of clinical suspicion for this entity.
authors.affiliation: Department of Clinical Pharmacology, Hospital Universitario La Paz, IdiPAZ, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.
authors.forename: Hoi Yan
authors.initials: HY
authors.lastname: Tong
authors.affiliation: Department of Clinical Pharmacology, Hospital Universitario La Paz, IdiPAZ, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.
authors.forename: Nicolás
authors.initials: N
authors.lastname: Medrano
authors.affiliation: Department of Clinical Pharmacology, Hospital Universitario La Paz, IdiPAZ, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.
authors.forename: Alberto Manuel
authors.initials: AM
authors.lastname: Borobia
authors.affiliation: Pediatric Emergency Department, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain.
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Ruiz
authors.affiliation: General Emergency Department, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain.
authors.forename: Ana María
authors.initials: AM
authors.lastname: Martínez
authors.affiliation: Pediatric Emergency Department, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain.
authors.forename: Julia
authors.initials: J
authors.lastname: Martín
authors.affiliation: General Emergency Department, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Quintana
authors.affiliation: Pediatric Emergency Department, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain.
authors.forename: Santos
authors.initials: S
authors.lastname: García
authors.affiliation: Department of Clinical Pharmacology, Hospital Universitario La Paz, IdiPAZ, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.
authors.forename: Antonio José
authors.initials: AJ
authors.lastname: Carcas
authors.affiliation: Department of Clinical Pharmacology, Hospital Universitario La Paz, IdiPAZ, School of Medicine, Universidad Autónoma de Madrid, Madrid, Paseo de la Castellana, 261, 28046, Spain. elena.ramirez@inv.uam.es.
authors.forename: Elena
authors.initials: E
authors.lastname: Ramírez
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage / Q000506:poisoning*; D000208:Acute Disease; D000293:Adolescent; D017677:Age Distribution; D018712:Analgesics, Non-Narcotic / Q000506:poisoning*; D056486:Chemical and Drug Induced Liver Injury / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D015331:Cohort Studies; D016001:Confidence Intervals; D062787:Drug Overdose / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D004636:Emergency Service, Hospital; D005260:Female; D006785:Hospitals, University; D006801:Humans; D017093:Liver Failure / Q000139:chemically induced* / Q000453:epidemiology; D008297:Male; D016017:Odds Ratio; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D013030:Spain / Q000453:epidemiology; D015996:Survival Rate
chemical_list: D018712:Analgesics, Non-Narcotic; D000082:Acetaminophen
keywords: acute liver failure; hepatotoxicity; paracetamol; poisoning