Abstract
Objective
To evaluate the risk of fulminant hepatic failure in relation to paracetamol overuse with therapeutic intent in febrile children.
Methods
It was a case control study. Paracetamol ingestion for the current febrile illness was compared between 25 cases of fulminant hepatic failure and 33 hospital age matched controls.
Results
Supra-therapeutic doses of paracetamol (mean 145 mg/kg/day) were consumed by all 25 cases compared to none in the control group. Mean paracetamol level in the cases and controls were, respectively, 26.84 μg/dl and 0.051 μg/dl (p<0.001). The mean duration of paracetamol intake prior to admission in cases was 3.45 days compared to 1.85 days in the control group. Nineteen, 5 and 3 were, respectively, graded as hepatic encephalopathy grade 1,2 and 3. All six patients in grade 2 and 3 had hepatomegaly compared to 78% in the grade 1. Four had jaundice and all were in grade 2 or 3. Mean alanine aminotransferase was 2781 U/L None of the randomly selected cases (6) had serological evidence of Hepatitis A, Hepatitis B or Dengue. Three cases died.
Conclusion
Exposure to multiple supratherapeutic doses of paracetamol is a risk factor to develop fulminant hepatic failure in children with an acute viral like febrile illness.
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Ranganathan, S.S., Sathiadas, M.G., Sumanasena, S. et al. Fulminant hepatic failure and paracetamol overuse with therapeutic intent in febrile children. Indian J Pediatr 73, 871–875 (2006). https://doi.org/10.1007/BF02859276
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DOI: https://doi.org/10.1007/BF02859276