Acetaminophen Toxicity in Children and Adolescents

What is acetaminophen and acetaminophen toxicity in children?

Acetaminophen (brand name Tylenol®) is a common over-the-counter (OTC) pain reliever and fever reducer for both children and adults. With the right dose, acetaminophen is very safe. Children are often prescribed acetaminophen for pain and fever reduction rather than aspirin because of the risk of Reye’s syndrome.

But if a person of any age takes more than the recommended dose of acetaminophen the result can be acetaminophen toxicity. This is a dangerous situation. The liver can’t process excessive doses of the medication. If a child takes too much acetaminophen (or takes the recommended amount for too long) toxins can build up in their body. This toxicity can cause vomiting, liver damage and death. It’s important to deal with the situation quickly.

What is the correct dose of acetaminophen for children?

Every child’s dosage may be different. Among other factors, your child’s dosage depends on

• Your child’s weight and age.
• What form the acetaminophen is taken (for example, liquid or pill).
• What other medications your child may be taking.

You and your healthcare provider will determine the right dose for your child.

Remember that any other prescription and OTC medications (such as cold medicines) also contain acetaminophen. Be sure to read the label of cold, sinus and other OTC medicines carefully to see how much acetaminophen (if any) it contains.

Always note your child’s dosage when you give them acetaminophen.

How common is acetaminophen toxicity in children?

Acetaminophen overdoses and toxicity are common. Anyone can have an adverse reaction to an overdose of acetaminophen. Every year in the United States, about 50,000 emergency room visits are due to Tylenol overdose or acetaminophen toxicity. Acetaminophen poisoning is a common cause of liver damage (hepatotoxicity).

Certain groups of people are more vulnerable to liver damage than others. Children and adolescents who already have liver disease or hepatitis A, B, or C are more likely to have severe symptoms after taking too much acetaminophen. Their livers struggle to process the medication, which can lead to liver failure.

How does a child get acetaminophen toxicity?

The liver acts as a filter for the body. It processes drugs and detoxifies substances in your system. Your child’s liver can stop working if it processes (metabolizes) too much of a medicine or has to metabolize it for too long. Acetaminophen toxicity occurs when your child:

• Exceeds the recommended dosage or takes multiple doses too close together.
• Takes the recommended amount too many days in a row.

What are the symptoms of acetaminophen toxicity in children?

Symptoms of acetaminophen overdose don’t appear right away. There may be no symptoms at all for up to 24 hours following an overdose. It’s important to note the time your child takes their acetaminophen, and in what form (liquid, tablet, capsule, time-release capsule/tablet) it was taken.

Some symptoms of acetaminophen toxicity are:

• Continued nausea, vomiting, pain in the right side of the abdomen under the ribs, loss of appetite, tiredness.
• Dark or bloody urine, or reduced amount or frequency of urine.
• Confusion, sleepiness and loss of consciousness.
• Skin and eyes that appear yellow (jaundice).
• Breathing problems.
• Blurry vision.

If you notice any of these symptoms in your child and you suspect an acetaminophen overdose, call an emergency number or go to the nearest emergency room right away. Call your local emergency number (such as 911), or your local poison control center, which can be reached through the national toll-free poison help hotline (1-800-222-1222).

How is acetaminophen toxicity in children diagnosed?

Your provider will examine your child and ask you about recent medications as far as how much was ingested, the approximate time it was taken, and the type of formulation (liquid, tablet, time-release capsule/tablet). To confirm a diagnosis of an acetaminophen overdose, blood tests are taken. These blood tests check:

• Levels of acetaminophen in the blood.
• Liver function, to determine how well the liver is working.

What do I do if my child has acetaminophen toxicity?

If your child has symptoms of an acetaminophen overdose after taking the medication, or you suspect an accidental overdose, seek emergency medical treatment immediately. Call local emergency (911) or your local poison control center, which can be reached through the national toll-free poison help hotline (1-800-222-1222).

What are the treatments for acetaminophen toxicity?

Treatment depends on when your child took the unsafe dose of acetaminophen. Based on when the overdose occurred, treatment may include:

• Pumping the stomach: If the overdose happened less than 30 minutes before seeking treatment, doctors might try to empty your child’s stomach using a tube inserted through the mouth. This procedure is called gastric lavage. It is only effective immediately following the overdose.
• Activated charcoal: Within 4 hours of the overdose, doctors may give your child a substance called activated charcoal (a powder mixed into a liquid). Activated charcoal works by binding toxic chemicals in the gastrointestinal tract. These chemicals then can pass through the intestines and exit the body without being absorbed.
• N-acetylcysteine (NAC): This medication can prevent liver damage after an acetaminophen overdose. It cannot reverse liver damage. Your child’s doctor may give this medication by mouth or through a vein (IV). It is most effective within 8 hours of the acetaminophen overdose. N-acetylcysteine (NAC) can cause nausea and vomiting. Your child will need to take several doses of NAC over 72 hours. The dosage depends on the level of acetaminophen in your child’s blood.
• Liver transplant: If liver damage is too severe, your child may need a liver transplant. Your doctor will explain the details of the process.

What are the complications associated with acetaminophen toxicity?

An acetaminophen overdose is a life-threatening emergency. If it isn’t treated soon after the overdose, it can lead to:

• Jaundice, a condition in which eyes and skin turn yellow because the liver cannot process toxins effectively.
• Severe liver damage and liver failure.
• Kidney failure.
• Pancreatitis (swelling of the pancreas).
• Death.

What can I do to help relieve symptoms of acetaminophen toxicity in children?

If you believe your child has taken more than the recommended dose of acetaminophen, call 911 or your local poison control center, which can be reached through the national toll-free poison help hotline (1-800-222-1222). Get treatment as soon as possible after your child took the medication.

How can you prevent acetaminophen toxicity in children?

To prevent an acetaminophen overdose, follow dosage instructions carefully. Talk to your child’s provider about the right dose based on your child’s weight and age. Don’t give more than one product that contains acetaminophen at the same time.

Other ways to prevent acetaminophen toxicity include:

• Keep medications out of reach. Store medicines away from children. Always make sure to close childproof lids.
• Read labels. Do not exceed dosage instructions. Some liquid forms of acetaminophen have different concentrations of the drug, so be sure to read labeling for each individual product. Talk to your healthcare provider if you have questions about how much to give.
• Avoid a double dose. Many medications (such as cold medicines) combine acetaminophen with other drugs. Read labels to see if acetaminophen is already in the medicine.
• Follow your provider’s orders. Don’t give your child acetaminophen longer than your provider recommends. Don’t give doses too close together, and always follow dosage instructions. With the liquid form of the medicine, use the measuring device included with the package to give the correct dose.
• Write dosage information down. Write down when the medicine was given and how much was given.
• Measure out the medicine in a well-lit area. Don’t give medicine in a darkened room. It increases the risk of giving a wrong dose.

What is the outlook for children who have acetaminophen toxicity?

The prognosis depends on how much acetaminophen the child took and how soon treatment started after the overdose. Children who receive fast treatment after acetaminophen poisoning have a much higher chance of recovering without long-term health problems, such as liver damage.

When should I call a healthcare provider about acetaminophen toxicity?

Acetaminophen toxicity is a life-threatening emergency. If you believe your child has taken an unsafe dose of acetaminophen, you should call 911, go to the emergency room or immediately call a poison control center. If you don’t know the number, it can be reached through the national toll-free poison help hotline (1-800-222-1222).