Paracetamol Poisoning in Children: Risks, Symptoms, and Treatment Methods. Dr. Narmin Azizova

Articles in English
13 May 2025

What is Paracetamol and How is it Used?

Paracetamol (acetaminophen) is one of the most widely used pain relievers and antipyretics globally. It is extensively applied to reduce high fever and relieve pain in children. Due to its minimal side effects and lack of adverse impact on the gastrointestinal system, as well as its safety in pregnancy, it is highly preferred. It is commonly found in combination with other substances in medications like “Coldrex,” “Gribex,” “Theraflu,” “Panadol,” and “Tylol.”

Risks of Poisoning

If the safe dosage of paracetamol is exceeded, toxic metabolites are produced in the liver, leading to severe damage. High doses can result in liver and kidney dysfunction, and even death. This risk is particularly higher in children, as parents sometimes fail to administer the correct dose or repeatedly use combined medications.

Clinical Symptoms of Poisoning

Paracetamol poisoning progresses through four main stages:

1. Initial Stage (0–24 hours):

  • Fatigue

  • Nausea

  • Vomiting

  • Loss of appetite
    Symptoms may be minimal or even absent at this stage.

2. Liver Injury Stage (24–72 hours):

  • Abdominal pain (upper right quadrant)

  • Elevated liver enzymes (ALT, AST)

  • Impairment of liver functions
    At this stage, medical intervention is crucial, and proper treatment can lead to recovery.

3. Acute Liver Failure Stage (72–96 hours):

  • Metabolic acidosis (increased acidity in the blood)

  • Blood clotting disorders

  • Renal failure

  • Encephalopathy (brain dysfunction)

  • Jaundice
    At this stage, the patient’s life is at risk, and urgent medical intervention is required.

4. Recovery or Complication Stage (96 hours and beyond):

  • In recovering patients, liver functions typically return to normal within 1–3 months.

  • Patients with severe damage may have a high risk of kidney failure.

Toxic Dose and Associated Risks

  • For children over 6 years and adults:

    • A single dose of 200 mg/kg or 10 grams (20 tablets) of paracetamol poses a high risk.

  • For children under 6 years:

    • Intake of more than 200 mg/kg can cause acute liver damage.

  • For prolonged use:

    • In children under 6 years: More than 100 mg/kg over three days.

    • In children over 6 years: More than 150 mg/kg over two days increases the risk of poisoning.

How is the Diagnosis Made?

  • Anamnesis and blood tests are used for diagnosis.

  • Blood paracetamol levels exceeding 200 μg/ml indicate a high risk of liver damage.

  • Elevated ALT, AST, GGT, and bilirubin levels, along with prolonged prothrombin time, reflect impaired liver function.

  • Increased creatinine levels indicate renal failure.

  • Also assessed:

    • Blood ammonia levels (elevated during encephalopathy)

    • Liver synthetic functions (albumin, prothrombin time)

Treatment Methods

  • First aid: Inducing vomiting or performing gastric lavage is recommended.

  • Activated charcoal can reduce the absorption of toxic substances.

  • In severe cases, N-acetylcysteine (NAC) is administered:

    • First 15 minutes: 150 mg/kg

    • Next 4 hours: 50 mg/kg

    • Over 16 hours: 100 mg/kg intravenously

  • Treatment is guided by the Rumack-Matthew Nomogram.

  • Plasmapheresis or hemodialysis may be employed in critical cases to remove toxic substances from the bloodstream.

Preventive Measures

  • Store medications out of children’s reach.

  • Be cautious when using combined medications with similar active ingredients.

  • Parents should use proper measuring spoons and cups to ensure accurate dosage.

  • Treatment duration should not exceed 10 days.

Pediatriya.az Recommendations:

  • Proper medication usage is essential for your child’s health.

  • If you are giving paracetamol-containing medication to your child, check whether it is combined with other medications.

  • Always administer medication under doctor’s guidance.

  • Never exceed the dosage indicated on the medicine box and record the time of each dose.

  • If fever persists for more than three days and paracetamol is ineffective, seek medical attention immediately.