Management of acetaminophen (paracetamol) poisoning in children and adolescents
- Kennon Heard, MD
Kennon Heard, MD
- Professor of Emergency Medicine
- University of Colorado School of Medicine
- Richard Dart, MD, PhD
Richard Dart, MD, PhD
- Director of Rocky Mountain Poison & Drug Center
- University of Colorado School of Medicine
- Section Editor
- Michele M Burns, MD, MPH
Michele M Burns, MD, MPH
- Section Editor — Pediatric Toxicology
- Assistant Professor of Pediatrics and Emergency Medicine
- Harvard Medical School
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
Since its clinical introduction in 1950, acetaminophen (N-acetyl-p-aminophenol; APAP; paracetamol) has become the most widely used analgesic-antipyretic in the United States. The popularity of acetaminophen among pediatricians increased when concerns were raised about an association between aspirin and Reye's syndrome.
Acetaminophen is available in hundreds of over-the-counter and prescription medications. Although it is remarkably safe when used at therapeutic doses, overdose of acetaminophen has been recognized to cause fatal and nonfatal hepatic necrosis since 1966 . In addition, repeated supratherapeutic doses can cause hepatotoxicity in children with certain risk factors, including decreased oral intake [2-4].
The management of acetaminophen intoxication in children and adolescents will be presented here. The clinical manifestations and diagnosis of acetaminophen poisoning in children and the evaluation and management of acetaminophen poisoning in adults is discussed separately. (See "Clinical manifestations and diagnosis of acetaminophen (paracetamol) poisoning in children and adolescents" and "Acetaminophen (paracetamol) poisoning in adults: Pathophysiology, presentation, and diagnosis" and "Acetaminophen (paracetamol) poisoning in adults: Treatment".)
The initial management of acetaminophen poisoning in children and adolescents depends upon the type of exposure and the patient’s clinical status:
Exploratory ingestions in young children — These exposures usually involve small amounts of acetaminophen in an otherwise asymptomatic child. Hepatotoxicity is rare. Treatment consists of the following (see 'Management of acute poisoning' below):
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- Exploratory ingestions in young children
- Intentional ingestions
- Inappropriate therapeutic dosing
- Iatrogenic intravenous overdose
- MANAGEMENT OF ACUTE POISONING
- Gastrointestinal decontamination
- - Indications
- - Administration
- - Adverse reactions
- Anaphylaxis (anaphylactoid reaction)
- - Duration of treatment
- - Monitoring during treatment
- Other therapies
- Extracorporeal removal
- Liver transplantation
- MANAGEMENT OF CHRONIC POISONING
- RESUMING ACETAMINOPHEN THERAPY
- ADDITIONAL RESOURCES
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS