Acetaminophen overdose in children and adolescents.

Ingestion of acetaminophen by young children and adolescents is common. Most children under the age of 6 who have ingested pediatric products can be safely managed at home. Children under the age of 6 who have taken a significant ingestion should be evaluated with a plasma level 4 or more hours after ingestion and, if toxic, treated with the antidote NAC prior to 16 hours postingestion. Less than 5 per cent of children under the age of 6 with toxic plasma levels will develop transient hepatic abnormalities. Adolescents who use acetaminophen in a suicidal or manipulative attempt should be seen and evaluated with a plasma acetaminophen level 4 or more hours postingestion. If the level is in the potentially toxic range on the nomogram, they should be treated prior to 16 hours postingestion with the antidote NAC. All patients should be evaluated for the possibility of other drugs or ingestants, especially if there is a change in the sensorium early in the course. The expected course of events in a patient with a toxic level of acetaminophen in the plasma is to have nausea, vomiting, and diaphoresis the first 24 hours. Following this, the patient should feel better but may begin to develop abnormalities of SGOT, SGPT, bilirubin, and prothrombin. Toxic patients will have peak enzyme levels at 72 to 96 hours. Over 99 per cent of patients will recover to normal values by 7 to 8 days postingestion. Long-term sequelae are not known.