Predicting concentrations in children presenting with acetaminophen overdose☆,☆☆,★
Section snippets
METHODS
A retrospective review of children (1 to 5 years) who presented to a children’s emergency department with accidental acetaminophen elixir ingestion from January 1995 to June 1997 was performed. The records of patients who had reported ingestions >50 mg/kg and who had serum acetaminophen concentrations >1.5 mg/L (minimum quantifiable concentration) at 4 hours were identified. These concentrations were compared with concentrations predicted by a 1-compartment, first order input, first order
RESULTS
A total of 218 children presented with accidental acetaminophen elixir ingestion, and of these 121 children (Table II) met the study criteria.
Mean age (SD) 33 (9) months Mean weight (SD) 14.6 (2.8) kg Median dose (range) 165 (50-822) mg/kg Median concentration (range) 30 (5.5-181) mg/L at 4 h
DISCUSSION
The Rumack-Matthew2 nomogram, widely used to guide management of acetaminophen overdose in adults and children, was derived from a study of 30 adult patients who ingested an overdose of acetaminophen.10 The half-life was <4 hours in all patients without liver damage. The Rumack-Matthew nomogram is simply a line drawn on a time-log concentration plot from 200 mg/L at 4 hours with a half-life of 4 hours. An ad hoc “possible toxicity” line 25% below the standard nomogram (150 mg/L at 4 hours and 5
References (26)
Scaling of blood parameters in mammals
Comp Biochem Physiol
(1980)- et al.
Plasma-paracetamol half-life and hepatic necrosis in patients with paracetamol overdose
Lancet
(1971) Gastrointestinal absorption of drugs
Med Clin North Am
(1974)Acetaminophen overdose in children and adolescents
Pediatr Clin North Am
(1986)- et al.
Influence of time until emesis on the efficacy of decontamination using acetaminophen as a marker in a pediatric population
Ann Emerg Med
(1993) - et al.
Acetaminophen ingestion in childhood: cost and relative risk of alternative referral strategies
J Toxicol Clin Toxicol
(1994) - et al.
Acetaminophen poisoning and toxicity
Pediatrics
(1975) Pharsight Trial Designer, Version 1
(1997)- et al.
Perioperative pharmacodynamics of acetaminophen analgesia in children
Anesthesiology
(1999)
A size standard for pharmacokinetics
Clin Pharmacokinet
The ecological implications of body size
Some suggestions for measuring predictive performance
J Pharmacokinet Biopharm
Cited by (68)
Deriving harmonised permitted daily exposures (PDEs) for paracetamol (acetaminophen) CAS #: 103-90-2
2020, Regulatory Toxicology and PharmacologyPharmacokinetics and Pharmacology of Drugs Used in Children
2019, A Practice of Anesthesia for Infants and ChildrenPharmacokinetics and Pharmacology of Drugs Used in Children
2018, A Practice of Anesthesia for Infants and ChildrenAccidental poisonings of domestic child
2016, Journal de Pediatrie et de PuericulturePaediatric poisoning
2013, Oh's Intensive Care Manual, Seventh EditionThe management of paracetamol poisoning
2009, Paediatrics and Child Health
- ☆
Supported in part by grants from “The Children’s Pain Trust” and “SmithKline Beecham Pharmaceuticals” (New Zealand). Dr Holford is a member of the Scientific Advisory Board for Pharsight and is a stockholder in the company.
- ☆☆
Reprint requests: B.J. Anderson, MD, Paediatric Intensive Care Unit, Auckland Children’s Hospital, Park Road, Grafton, Auckland, New Zealand.
- ★
0022-3476/99/$8.00 + 0 9/21/99435