Paracetamol Poisoning in Pediatrics: 7 Critical Facts Every Parent Must Know

Understanding Paracetamol Poisoning in Children

Paracetamol is one of the most commonly used medications for pain and fever in children. However, an overdose can lead to severe toxicity and even liver failure. Knowing the signs, risks, and treatment options is crucial for every parent and caregiver.

1. What Is Paracetamol Poisoning?

Paracetamol poisoning occurs when a child ingests a toxic dose of the drug, leading to harmful effects on the liver and other organs. The toxicity threshold varies by age and weight, but a dose exceeding 150 mg/kg is considered dangerous.

2. Recommended Paracetamol Dosage for Children

To prevent overdose, it is essential to adhere to the correct dosing guidelines:

• Infants (2-3 months): 15 mg/kg every 6-8 hours (maximum 4 doses in 24 hours)
• Children (3 months – 12 years): 10-15 mg/kg every 4-6 hours (maximum daily dose: 60 mg/kg, not exceeding 4 g/day)
• Adolescents (12 years and older): Follow adult dosing guidelines (500-1000 mg every 4-6 hours, max 4 g/day)

3. Causes of Paracetamol Overdose in Children

Several factors contribute to accidental paracetamol overdose in children:

• Incorrect Dosage: Giving the wrong dose due to miscalculation.
• Multiple Medications: Some cold and flu medicines also contain paracetamol.
• Unsupervised Ingestion: Children may accidentally consume tablets or syrups left within their reach.
• Chronic Use: Repeated doses over time can lead to cumulative toxicity.

4. Symptoms of Paracetamol Poisoning

Paracetamol overdose symptoms occur in four stages:

Stage 1 (0-24 hours):

• Nausea and vomiting
• Loss of appetite
• Sweating and general discomfort

Stage 2 (24-72 hours):

• Liver enzyme elevation
• Abdominal pain (especially in the upper right side)
• Jaundice and dark urine

Stage 3 (72-96 hours):

• Severe liver damage
• Confusion and drowsiness
• Multi-organ failure (in severe cases)

Stage 4 (4-14 days):

• Recovery in mild cases
• Liver failure or death in severe cases

5. Diagnosis of Paracetamol Poisoning

Early diagnosis is key to preventing complications. Doctors perform the following tests:

• Blood Paracetamol Levels: Measured 4 hours after ingestion.
• Liver Function Tests: Assess liver enzyme levels.
• Coagulation Profile: Checks blood clotting ability.

6. Treatment of Paracetamol Overdose in Pediatrics

Immediate Steps for Parents

• Seek emergency medical help immediately.
• Do not induce vomiting.
• If the overdose occurred within 1 hour, activated charcoal may help reduce absorption.

Medical Treatment Options

• N-Acetylcysteine (NAC): Antidote that helps prevent liver damage if given within 8 hours.
• Intravenous Fluids: Maintain hydration and kidney function.
• Liver Transplant: In severe cases of liver failure.

7. How to Prevent Paracetamol Poisoning in Children

Preventing accidental ingestion is crucial:

• Use the correct dosage based on age and weight.
• Check labels of combination medicines for hidden paracetamol.
• Store medications out of children’s reach and in child-proof containers.
• Educate caregivers about proper dosing and risks.

8. When to Seek Emergency Help

• If a child has ingested more than 150 mg/kg of paracetamol.
• If symptoms like vomiting, jaundice, or drowsiness appear.
• If unsure about the ingested dose, always consult a doctor immediately.

Final Thoughts

Paracetamol poisoning in children is a medical emergency that requires prompt action. Understanding the risks, symptoms, and treatment can help parents prevent and respond effectively to overdose situations.