PROSPECTIVE STUDY OF MULTIPLE SUPRATHERAPEUTIC ACETAMINOPHEN DOSES IN FEBRILE CHILDREN

Background: Repeated doses of acetaminophen given for therapeutic reasons have been reported to cause hepatotoxicity in adults and children. We studied the effects of repeated Acetaminophen (APAP) overdoses administered for therapeutic purposes. Methods: Forty four children, aged 2 months to 10 years, who were referred to the Emergency Department with a fever of [is greater than] 38.5 [degrees] for more than 48 hours, and received APAP in a dosage [is greater than] 60 mg/kg/day. AST, ALT and APAP blood levels were measured. Results: The mean total daily dose of APAP was 92 [+ or -] 26 (63-171) mg/kg. There were no cases of severe liver injury. In 4 children (9.1%) an elevation of AST and ALT was found. One patient had a slight elevation of AST only. Among children with AST and ALT levels of [is greater than or equal to] 45 IU/L, those who received APAP in a dosage of [is greater than] 100 mg/kg/day had marginally significantly higher levels of AST (p = 0.05) and ALT (p = 0.07) as compared to those who received 60-100 mg/kg/day. APAP blood levels ranged from 0 to 23 mcg/mL. No correlation was found between the time since the last dose of APAP and the drug level in the serum. Conclusions: This study shows that in ill children receiving repeated supratherapeutic doses of acetaminophen, abnormalities in liver function may occur. Both the medical and the pharmaceutical industries should be responsible for providing adequate, accurate and easily understood information to parents and patients on the judicious use of this common medication.
Kozer E, Barr J, Lahat E, Bulkowstein M, Avgil M, Greenberg R, Matias A, Berkovitch M. Department of Pediatric Emergency Medicine, Clinical Pharmacology and Toxicology Unit, Clinical Biochemistry, Assaf Harofeh [...]