Has the time come to stop routine N-acetylcysteine treatment in young children in Denmark? A review of 300 suspected paracetamol overdoses in children aged 0-6 years

Abstract

AIM: To evaluate the prevalence of potentially hepatoxic paracetamol ingestion and associated N-acetylcysteine treatment in young children suspected of paracetamol poisoning.

METHODS: A retrospective cohort study of children aged 0-6 years suspected of paracetamol poisoning with a related plasma-paracetamol measurement in the Capital Region of Denmark in the period 2010-2017. Data from the clinical laboratory system were linked to data from electronic patient records via the unique identification number given to all Danish residents.

RESULTS: Of 297 children included, suspected single paracetamol overdoses were present in 281 (95%). Sixty-nine per cent were treated with N-acetylcysteine, and the mean treatment period was 20.3 h (SD 20.8). A maximum of 6 (2%) of the children suspected of single overdose had plasma-paracetamol concentrations that exceeded the recommended treatment thresholds. No cases of severe hepatotoxicity were registered. Adverse events to N-acetylcysteine-treatment were registered in 3 (2%) children including one anaphylactoid reaction (0.5%).

CONCLUSION: This study shows that initiating N-acetylcysteine as a 'one size fit all' treatment regimen in all children aged 0-6 years with a suspected single paracetamol overdose leads to substantial overtreatment. The data support that it is feasible to initiate N-acetylcysteine within 10 h based on an early plasma-paracetamol test.

Original languageEnglish
JournalActa paediatrica
Volume111
Issue number3
Pages (from-to)667-674
Number of pages8
ISSN1651-2227
DOIs
Publication statusPublished - Mar 2022

Keywords

  • Acetaminophen
  • Acetylcysteine/therapeutic use
  • Analgesics, Non-Narcotic
  • Antidotes/therapeutic use
  • Child
  • Child, Preschool
  • Denmark/epidemiology
  • Humans
  • Infant
  • Infant, Newborn
  • Retrospective Studies

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