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Childhood hepatotoxicity with paracetamol doses less than 150 mg/kg per day
Author(s) -
Hynson Jenny L,
South Mike
Publication year - 1999
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/j.1326-5377.1999.tb123758.x
Subject(s) - medicine , citation , general hospital , pediatrics , library science , humanities , art , computer science
B Case 2: A 12-year-old,43kg boy with Duchenne'smusculardystrophy was admitted for posterior spinal fusion and tendon-release surgery. He was anaesthetised using propofol and nitrous oxide, and during the operation required transfusion for a one-litre blood loss. He returned to the ward on a morphine infusion (20llg/kg/h) and cephazolin (1g eight-hourly). Over the next 24 hours he received a total dose of 3000 mg (70 mg/kg) paracetamol rectally. Similar total doses were given over the next five days, with a maximumof 4650mg (108 mg/kg) in any 24-hour period. Liver function tests taken the day after surgery revealed an AST level of 193U/L (Figure B) and a -y-glutamyl transpeptidase (GGT) level of 43 U/L (normal range, <40UIL). He developed paralytic ileus 48 hours after surgery; this resolved with intravenous hydration. On day seven, he became irritable and disoriented and was pale, icteric and lethargic. Results of investigations were: serum bilirubin, 120llmol/L; GGT,68UIL; AST, 7377 U/L; and ammonia, 881lmoi/L (normal range, <50llmoI/L). His serum paracetamollevel was 5281lmol/L. The haemoglobin level was 68 giL and he received two units of packed cells. Serology for hepatitis Band C was negative. The paracetamol level was 2061lmoi/L 34 hours after the last dose, but, as the liver enzyme levels were falling and the child's conscious state improving, N-acetylcysteine was not administered. He was discharged 22 days after surgery with an AST level of 113U/L. The patient was discharged after seven days, with an AST level of 171 U/L. Three months later she was completely well, with normal liver function tests.