Department of Clinical Pharmacology, Hospital Universitario La Paz, IdiPAZ, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.
Pediatric Emergency Department, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain.
World J Pediatr. 2017 Feb;13(1):76-83. doi: 10.1007/s12519-016-0046-6. Epub 2016 Jul 15.
There are few data on hepatotoxicity induced by acute or chronic paracetamol poisoning in the pediatric population. Paracetamol poisoning data can reveal the weaknesses of paracetamol poisoning management guidelines.
We retrospectively studied the patients of less than 18 years old with measurable paracetamol levels, who were brought to the emergency department (ED) of La Paz University Hospital, Madrid, Spain, for suspected paracetamol overdoses between 2005 and 2010.
Ninety-two patients with suspected paracetamol poisoning were identified. In 2007, the incidence of paracetamol poisoning in the pediatric population was 0.8 [Poisson-95% confidence interval (CI): 0.03-3.69] per 10 000 inhabitants aged less than 18 years. The incidence in the same year was 1.53 (Poisson-95% CI: 0.24-5.57) per 10 000 patients in the pediatric ED. The most common cause of poisoning was attempted suicide (47.8%) in teenagers with a median age of 15 years, followed by accidental poisoning (42.2%) in babies with a median age of 2.65 years. Difference was seen in the frequency of hepatotoxicity between acute and chronic poisoning cases. Only 1 of 49 patients with acute poisoning showed hepatotoxicity [acute liver failure (ALF)], whereas 7 of 8 patients with chronic poisoning showed hepatotoxicity (3 cases of ALF). The average time to medical care was 6.83 hours for acute poisoning and 52.3 hours for chronic poisoning (P<0.001).
Chronic paracetamol poisoning is a potential risk factor for hepatotoxicity and acute liver failure. Delays in seeking medical help might be a contributing factor. Clinicians should have a higher index of clinical suspicion for this entity.
儿科人群中，急性或慢性扑热息痛中毒引起的肝毒性数据较少。扑热息痛中毒数据可以揭示扑热息痛中毒管理指南的不足之处。
我们回顾性研究了 2005 年至 2010 年间，因疑似扑热息痛过量而被带到西班牙马德里拉帕兹大学医院急诊科的年龄小于 18 岁的、有可测量扑热息痛水平的患者。
确定了 92 例疑似扑热息痛中毒的患者。2007 年，儿科人群扑热息痛中毒的发病率为每 10 000 名年龄小于 18 岁的居民中 0.8 例（泊松-95%可信区间：0.03-3.69）。同年，儿科急诊科每 10 000 例患者中扑热息痛中毒的发病率为 1.53 例（泊松-95%可信区间：0.24-5.57）。中毒最常见的原因是青少年自杀（47.8%），中位年龄为 15 岁，其次是婴儿意外中毒（42.2%），中位年龄为 2.65 岁。急性和慢性中毒病例的肝毒性发生率存在差异。仅 49 例急性中毒患者中有 1 例出现肝毒性[急性肝衰竭（ALF）]，而 8 例慢性中毒患者中有 7 例出现肝毒性（3 例 ALF）。急性中毒的平均就医时间为 6.83 小时，慢性中毒为 52.3 小时（P<0.001）。
慢性扑热息痛中毒是肝毒性和急性肝衰竭的潜在危险因素。寻求医疗帮助的延迟可能是一个促成因素。临床医生应该对此类疾病有更高的临床怀疑指数。
