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Acetaminophen and Liver Failure
Acetaminophen is one of the most commonly used medicines in children. One brand name, Tylenol, is known by most parents in the U.S. Often used by itself to relieve pain or to reduce fevers, it is also a common part of multi-ingredient medicines (in preparations such as some forms of Benadryl, Contac, Dayquil, Nyquil, Robitussin, Sudafed, Theraflu, Triaminic, Vicks 44, and Vicodin). With the millions of doses given each year, the number of problems encountered is quite small. Nevertheless, a study published in the December 2005 Hepatology reminds us to treat this common remedy with proper respect. According to the study, acetaminophen overdose has become the single largest cause of acute liver failure in the United States – accounting by itself for 42 percent of all cases. Some people with liver failure in the study took too much all at once (on average of 24 times the recommended dose); others overdosed by taking a much smaller amount, but inadvertently repeating it over multiple doses. This study only looked at adults with liver failure, but we already know that acetaminophen can do the same to children – with either large, single overdoses or with smaller chronic overdoses. I’m a fan of keeping kids comfortable when they are sick, especially if it helps them to sleep, but it’s important to be aware that pushing the dose up of medicines beyond recommendations is a dangerous idea. And whenever kids are taking more than one medicine, check the ingredient list to be sure you are not getting too much of any one item.
Alan Greene MD FAAP
Reviewed by Alan Greene MD FAAP December 2005
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December 3, 2005 | Permalink
Comments
hey great site... i want to know if we can use the acetaminophen at animals???
Posted by: no prescription needed | Mar 17, 2009 8:52:04 PM
Congratulations on your page, it is really interesting
Posted by: Pharmacy Drugstore | Mar 17, 2009 12:37:01 PM
Hi! I just had to take my three children (twin girls, age 3 and little boy, 22 months) to the Emergency Room last Thursday night after they found their way into two bottles of children's Tylenol. One bottle was liquid, and at least 3/4 full, and the other was the meltaway tabs, and it was at least 1/2 full. I keep our medicine in a cabinet that I have to get a chair to even get medicine out of it. But somehow (and I'm not really that surprised) my little climber twin got up in the cabinet, found the two bottles, and managed to open both child-proof caps. I found them in our hallway...all three of them with sticky red goo all over their face...both bottles were empty, and there was not a drop on the floor or their clothing. I panicked of course. I called poison control and tried to be calm. The nice lady on the phone asked for their weights and explained that since they were all small and there was no way of knowing who ingested what amount, that they needed to go the the ER. At the ER, liquid charcoal was administered and we had to wait for three hours until a blood test was done to make sure they were okay. They were all fine, but my intuition was true...my little climber had the highest level of acetaminophen in her blood...nowhere near toxic, but way above my other two...and while we were at the ER, she performed her child-proof bottle opening skills for the physician. She actually opened the bottles in less time than in would take me! My point is, that I did not realize Acetominophen could be so dangerous. I have never given over the recommended dose, but know many parents who do. And I am shocked over it. I am blessed that my little girl didn't reach for something stronger. I thought all of our medications were out of their reach. I was wrong! I know she reached for the tylenol because she knew it tasted good. But if she had gotten a bottle of benadryl, or phenergan, etc...I just don't know what would have happened! Anyway, I have learned a lesson! I purchased a lock box...really it is a home security fire proof box. All of our medications are now safely locked away in that box! I will not take any chances, and I beg that other parents do the same. Administer medications only as directed, and keep medicine completely out of reach of children....Don't Underestimate Them!!!! I never will again!
Posted by: Shasta | Dec 30, 2005 8:04:28 PM
Doc,
I dont think that anyone seems to following the dosage of paracetamol at all. Dont you think that paracetamol should be given as: 10mg/kg body weight per dose and max of about 4-6 doses except in orthopaedic use if it is justified?
Posted by: Dr Gurusamy Thamaraiselvan | Dec 9, 2005 6:39:33 AM
Would it not be better for pediatricians to start endorsing the use of children's Motrin (ibuprofen) in place of the oft recommended acetominophen for pain and fever. As I understand, it has less risk and does not need to be taken as frequently to have desired effect.
Posted by: Jennifer | Dec 7, 2005 8:48:58 AM
