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Early predictors of severe acetaminophen‐induced hepatotoxicity in a paediatric population referred to a tertiary paediatric department
Author(s) -
Hedeland Rikke Lindgaard,
Andersen Jesper,
Askbo Natasha,
Iskandar Amne,
Jørgensen Marianne Hørby
Publication year - 2014
Publication title -
acta paediatrica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.772
H-Index - 115
eISSN - 1651-2227
pISSN - 0803-5253
DOI - 10.1111/apa.12740
Subject(s) - medicine , acetaminophen , emergency department , pediatrics , population , intensive care medicine , emergency medicine , anesthesia , environmental health , psychiatry
Aim The data on severe acetaminophen‐induced hepatotoxicity in children are very limited. This study explored the dose–response relationship between ingested acetaminophen and hepatotoxicity, the early biochemical and clinical predictors of hepatotoxicity, the impact of early N‐acetylcysteine treatment on hepatotoxicity and the incidence of nephrotoxicity. Methods We carried out a retrospective case study on 25 children aged 11–16 years with severe acetaminophen poisoning. Results Initial biochemical parameters predicted hepatotoxicity, defined as the maximum levels of the international normalised ratio ( INR ) and alanine aminotransferase ( ALT ). Significant relationships were found between: (1) the maximal INR and, for example, the initial bilirubin (p = 0.0003) and initial phosphate (p = 0.003), (2) the maximal ALT and, for example, the initial INR (p = 0.0003) and initial creatinine (p = 0.002), (3) the number of prehospital vomiting episodes and, for example, the maximal INR (p = 0.013) and maximum ALT (p = 0.0005) and (4) the time of N‐acetylcysteine initiation and, for example, maximum ALT (p = 0.001) and maximum gamma‐glutamyl transferase ( GGT ) (p = 0.007). The incidence of nephrotoxicity was 12%. There was no significant relationship between the amount of ingested acetaminophen and the degree of hepatotoxicity. Conclusion Paediatric patients at increased risk of severe hepatotoxicity were identified by early biochemical parameters, prehospital vomiting episodes and latency time before N‐acetylcysteine initiation.