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The Hemodynamic Effect of Intravenous Paracetamol in Children: A Retrospective Chart Review

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Abstract

Aim

Studies in adults have reported frequent episodes of blood pressure drops following intravenous paracetamol administration. We aimed to investigate the hemodynamic effects of intravenous paracetamol in critically ill children.

Methods

The charts of 100 pediatric intensive care patients (age range 0.1–18 years) who were treated with intravenous paracetamol between March and September 2017 were retrospectively reviewed. A hemodynamic event was defined as a drop of > 15% in systolic or mean arterial blood pressure within 120 min after drug administration. Hypotension was defined as either a drop in systolic blood pressure (SBP) below the 5th percentile for age or a hemodynamic event associated with tachycardia, increased lactate level, or treatment with a fluid bolus or vasopressors.

Results

A hemodynamic event was observed in 39 patients (39%). In these patients, SBP was in the pre-hypertension or hypertension values in 36/39 patients before paracetamol administration, median (IQR) SBP decreased from the 99th (95–99) percentile for age before to the 50th (50–95) percentile after paracetamol (p < 0.001) and mean heart rate was 137 bpm before treatment and 115 bpm after (p = 0.002). SBP values did not drop below the 5th percentile in any patient. In 15 patients diagnosed with shock on admission, paracetamol treatment did not cause an increase in vasopressor treatment after drug administration.

Conclusions

In the present study of critically ill pediatric patients, intravenous paracetamol administration was associated with a drop in SBP from high to normal values for age, possibly due to pain relief, with no evidence for a negative hemodynamic event.

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Acknowledgements

This work was performed in partial fulfillment of the M.D. thesis requirements of the Sackler Faculty of Medicine for Matan Friedman.

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Author notes

  1. Elhanan Nahum and Matan Friedman contributed equally to this work.

Authors and Affiliations

  1. Pediatric Intensive Care Unit, Schneider Children’s Medical Center in Israel, 14 Kaplan Street, 4920235, Petach Tikva, Israel

    Elhanan Nahum, Eytan Kaplan, Avichai Weissbach & Gili Kadmon

  2. Sackler Faculty of Medicine, Tel Aviv University, PC 39040, 69978, Tel Aviv, Israel

    Matan Friedman

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  1. Elhanan Nahum
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Correspondence to Gili Kadmon.

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Conflict of interest

Elhanan Nahum, Matan Friedman, Eytan Kaplan, Avichai Weissbach, and Gili Kadmon declare that they have no potential conflicts of interest that might be relevant to the contents of this manuscript.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Nahum, E., Friedman, M., Kaplan, E. et al. The Hemodynamic Effect of Intravenous Paracetamol in Children: A Retrospective Chart Review. Pediatr Drugs 21, 177–183 (2019). https://doi.org/10.1007/s40272-019-00336-8

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  • DOI: https://doi.org/10.1007/s40272-019-00336-8

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