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Acetaminophen and children: Why dose matters

How much acetaminophen is too much?

Too much acetaminophen overloads the liver's ability to process the drug safely. An acetaminophen overdose can lead to life-threatening liver problems. How much acetaminophen is too much varies depending on the child's age and weight. Consider these guidelines from the American Association of Poison Control Centers:

  • Age 5 and younger. Seek emergency care if your child age 5 or younger swallows 91 mg of acetaminophen per pound of his or her weight (200 mg per kg) in eight hours.
  • Age 6 and older. Seek emergency care if your child age 6 or older swallows 91 mg of acetaminophen per pound of his or her weight (200 mg per kg) or at least 10 grams of acetaminophen — whichever is less — in 24 hours; or 68 mg of acetaminophen per pound of his or her weight (150 mg per kg) or at least 6 grams of acetaminophen — whichever is less — per 24-hour period for 48 hours or longer.

How is an acetaminophen overdose treated?

If your child takes more than the recommended amount of acetaminophen but not enough to cause a toxic reaction, medical care isn't likely necessary. Be cautious, however. If you're concerned about a possible acetaminophen overdose and notice early signs or symptoms of an overdose — nausea, vomiting, lethargy and abdominal pain within 24 hours — call your local poison control center at 800-222-1222 or seek emergency care. If possible, note the strength or concentration of acetaminophen in the product to help poison control or the emergency responders assess your child.

In the hospital, a child with an acetaminophen overdose will have a blood test to determine if the concentration in his or her blood is toxic. If necessary, an antidote might be given within eight to 10 hours after the acetaminophen is swallowed to reverse the effects of the acetaminophen. Left untreated, a serious acetaminophen overdose can be fatal within a few days.

How can an acetaminophen overdose be prevented?

Before you give your child acetaminophen, carefully consider whether he or she needs it. For example, a fever is a common sign of illness, but that's not necessarily a bad thing. In fact, fevers seem to play a key role in fighting infections. The main goal of treating a child who has a fever is to improve his or her comfort — not to normalize his or her body temperature. If you do give your child acetaminophen, keep in mind that it might take up to an hour to lower his or her fever.

In addition:

  • Follow the directions and weight-based dose recommendations printed on medication labels.
  • Use the measuring device that comes with your child's medication. Don't use household teaspoons — which can vary in size — to measure liquid acetaminophen.
  • Don't give your child acetaminophen when he or she is taking other medications containing acetaminophen.
  • Don't give your child adult formulations of acetaminophen.
  • Securely replace child-resistant caps after using medication and store all medication out of your child's reach.

Careful use of acetaminophen and prompt treatment in case of an overdose can help prevent a tragedy.

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References
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  2. James LP, et al. Acetaminophen-associated hepatic injury: Evaluation of acetaminophen protein adducts in children and adolescents with acetaminophen overdose. Clinical Pharmacology and Therapeutics. 2008;84:684.
  3. Kanter MZ. Comparison of oral and i.v. acetylcysteine in the treatment of acetaminophen poisoning. American Journal of Health-System Pharmacy. 2006;63:1821.
  4. Brok J, et al. Interventions for paracetamol (acetaminophen) overdose. Cochrane Database of Systematic Reviews. 2006:CD003328.
  5. Mahadevan SK, et al. Paracetamol induced hepatotoxicity. Archives of Disease in Childhood. 2006;91:598.
  6. Smith DH. Managing acute acetaminophen toxicity. Nursing. 2007;37:58.
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  8. Acetaminophen (paracetamol): Pediatric drug information. http://www.uptodate.com/home/index.html. Accessed April 20, 2011.
  9. Sullivan JE, et al. Fever and antipyretic use in children. Pediatrics. 2011;127:580.
  10. Schillie SF, et al. Medication overdoses leading to emergency department visits among children. American Journal of Preventive Medicine. 2009;37:181.
  11. Acetaminophen. Micromedex Healthcare Series. http://www.micromedex.com. Accessed March 9, 2011.
  12. Carlton L, et al. Drug doses. In: Custer JW, et al. Harriet Lane Handbook. 18th ed. Philadelphia, Pa.: Mosby Elsevier; 2008. http://www.mdconsult.com/books/page.do?eid=4-u1.0-B978-0-323-05303-7..50034-9--cesec2&isbn=978-0-323-05303-7&type=bookPage&sectionEid=4-u1.0-B978-0-323-05303-7..50034-9--cesec2&uniqId=239895152-2#4-u1.0-B978-0-323-05303-7..50034-9--cesec2. Accessed April 25, 2011.
  13. Acetadote (prescribing information). Nashville, Tenn.: Cumberland Pharmaceuticals Inc.; 2011. http://www.acetadote.net/2010_Acetadote_PI_Jan11_Clean.pdf. Accessed April 25, 2011.
  14. Acetaminophen poisoning. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merckmanuals.com/professional/sec21/ch326/ch326c.html?qt=acetaminophen&alt=sh. Accessed April 25, 2011.
  15. Valasek A. Poisonings. In: Custer JW, et al. Harriet Lane Handbook. 18th ed. Philadelphia, Pa.: Mosby Elsevier; 2008. http://www.mdconsult.com/books/page.do?eid=4-u1.0-B978-0-323-05303-7..50004-0--cesec19&isbn=978-0-323-05303-7&type=bookPage&sectionEid=4-u1.0-B978-0-323-05303-7..50004-0--cesec19&uniqId=239954106-2#4-u1.0-B978-0-323-05303-7..50004-0--cesec19. Accessed April 26, 2011.
  16. Shelov SP, et al. Caring for Your Baby and Young Child: Birth to Age 5. 5th ed. New York, N.Y.: Bantam Books; 2009:750.
  17. Public health advisory: FDA recommends that over-the-counter (otc) cough and cold products not be used for infants and children under 2 years of age. U.S. Food and Drug Administration. http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/DrugSafetyInformationforHeathcareProfessionals/PublicHealthAdvisories/UCM051137. Accessed April 26, 2011.
  18. 10 tips to prevent an accidental overdose. U.S. Food and Drug Administration. http://www.fda.gov/downloads/ForConsumers/ConsumerUpdates/UCM253692.pdf. Accessed May 5, 2011.
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HO00002 June 18, 2011

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