ACETAMINOPHEN: POTENTIAL PEDIATRIC HAZARD

Acetaminophen, long popular in Europe, has received increasing use in the United States as an analgesic and antipyretic, in both adult and pediatric practice. This increased use has come about partly because of concern over side effects of aspirin, especially its interference with blood-clotting mechanisms. Pediatric use of acetaminophen has been facilitated because it can be formulated into a stable suspension, easy to administer to children. Acetaminophen is available in many forms and formulations, alone and in combination, in both prescription and over-the-counter products. The table at the end of this section, admittedly incomplete, lists some 200 brand names of products containing this compound which are marketed in the United States. The extensive availability of acetaminophen increases the probability of accidental ingestion of toxic quantities by infants and children. Although package inserts characterize this drug as having exceptional safety in recommended doses, ingestion of moderately large quantities can cause kidney and liver damage resulting sometimes in death. Adverse side effects have been reported from lesser quantities. It is, therefore, important to alert practitioners to the potential toxicity, symptomatology and procedures for handling overdose. A highly significant aspect in such incidents is that early signs of poisoning may be minimal, even in cases where death ultimately occurs. Unaware of this, a physician might delay intensive therapy. Poisoning by acetaminophen and its treatment have been extensively studied in the United Kingdom where consumption of this drug has progressively risen over the past decade and has been accompanied by an increasing number of poisonings.