Pediatr Emerg Med J.  2024 Oct;11(4):162-169. 10.22470/pemj.2024.01032.

Pediatric acetaminophen intoxication in Korea: characteristics and prognosis

• Sohn SJ
• Lee YJ
• Lim TJ

• KMID: 2559549
• DOI: http://doi.org/10.22470/pemj.2024.01032

Abstract

Purpose
Acetaminophen overdose accounts for the largest proportion of pediatric poisoning reported in South Korea. We investigated the characteristics and prognosis of pediatric acetaminophen overdose.
Methods
We retrospectively reviewed medical records of patients younger than 19 years with acetaminophen overdose who visited the emergency department (ED) of Pusan National University Children’s Hospital from January 2009 through December 2022. We investigated age, sex, dose, clinical findings, and treatment, and compared the differences in the variables according to the intentionality of ingestion and the presence of hepatotoxicity.
Results
Among the 132,691 pediatric patients who visited the ED during the period, 555 did for drug intoxication, of whom 51 with acetaminophen overdose were included in this study. The overdose was intentional in 43 patients (the intentional group; median age, 15.4 years [interquartile range, 13.9-16.8]) and accidental in 8 patients (the accidental group; 7.7 years [2.3-15.4]). The mean ingested dose was higher in the intentional group than in the accidental group (170.3 ± 129.0 vs. 105.3 ± 37.5 mg/kg; P = 0.016). Hospitalization tended to be implemented more frequently in the intentional group (53.5% vs. 12.5%; P = 0.081). All patients with hepatotoxicity (n = 10) belonged to the same group, and showed a higher or longer median age (15.9 [14.6-17.1] vs. 13.8 years [13.7-16.4]; P = 0.030), mean ingested dose (13,230.0 ± 10,544.8 vs. 7,654.0 ± 6,752.3 mg; P = 0.043), mean time from ingestion to arrival at the ED (22.6 ± 23.4 vs. 5.5 ± 6.4 hours; P = 0.048), and frequency of hospitalization (80.0% vs. 39.0%; P = 0.048).
Conclusion
It is necessary to track the occurrence of hepatotoxicity in patients who intentionally ingest acetaminophen.

Keyword

Acetaminophen; Korea; Pediatrics; Poisoning; Self-Injurious Behavior

Figure

• 

  Fig. 1. Figures by year, age group, and sex of patients who visited the emergency department with acetaminophen overdose from 2010 through 2022. The numbers of patients are plotted per the sex (A) and age group (B and C). These trends shows similar patterns with the equivalent values based on the Korean Health Insurance Review and Assessment Service data (D-F).

Reference

References

1. Kanabar DJ. A clinical and safety review of paracetamol and ibuprofen in children. Inflammopharmacology. 2017; 25:1–9.

2. Alander SW, Dowd MD, Bratton SL, Kearns GL. Pediatric acetaminophen overdose: risk factors associated with hepatocellular injury. Arch Pediatr Adolesc Med. 2000; 154:346–50.

3. Squires RH Jr, Shneider BL, Bucuvalas J, Alonso E, Sokol RJ, Narkewicz MR, et al. Acute liver failure in children: the first 348 patients in the pediatric acute liver failure study group. J Pediatr. 2006; 148:652–8.

4. Moon J, Chun B, Cho Y, Lee S, Jung E, et al. Characteristics of emergency department presentations of pediatric poisoning between 2011 and 2016: a retrospective observational study in South Korea. Pediatr Emerg Care. 2021; 37:e261–8.

5. Ministry of Health and Welfare (MOHW), Republic of Korea. Home medicine will be sold at convenience stores starting in November this year [Internet]. MOHW; c2024 [cited 2024 Apr 10]. Available from: https://www.mohw.go.kr/board.es?mid=a10503000000&bid=0027&act=view&list_no=271028&tag=&nPage=1. Korean.

6. Big Data Strategy Department, Health Insurance Review and Assessment Service (HIRA). Disease subclassification (4th level corporal) statistics [Internet]. HIRA; c2023 [cited 2024 Apr 10]. Available from: https://opendata.hira.or.kr/op/opc/olap4thDsInfoTab2.do. Korean.

7. Gedeborg R, Svennblad B, Holm L, Sjogren H, Bardage C, Personne M, et al. Increased availability of paracetamol in Sweden and incidence of paracetamol poisoning: using laboratory data to increase validity of a population-based registry study. Pharmacoepidemiol Drug Saf. 2017; 26:518–27.

8. O'Rourke M, Garland MR, McCormick PA. Ease of access is a principal factor in the frequency of paracetamol overdose. Ir J Med Sci. 2002; 171:148–50.

9. Prescott LF, Park J, Ballantyne A, Adriaenssens P, Proudfoot AT. Treatment of paracetamol (acetaminophen) poisoning with N-acetylcysteine. Lancet. 1977; 2:432–4.

10. U.S. Centers for Disease Control and Prevention (CDC), National Center for Health Statistics. CDC growth charts [Internet]. U.S. Department of Health & Human Services; c2024 [cited 2024 Feb 15]. Available from: https://www.cdc.gov/growthcharts/cdc_charts.htm.

11. Mintegi S, Azkunaga B, Prego J, Qureshi N, Dalziel SR, Arana-Arri E, et al. International epidemiological differences in acute poisonings in pediatric emergency departments. Pediatr Emerg Care. 2019; 35:50–7.

12. Koh SH, Tan KHB, Ganapathy S. Epidemiology of paediatric poisoning presenting to a children's emergency department in Singapore over a five-year period. Singapore Med J. 2018; 59:247–50.

13. Hon KL, Ho JK, Leung TF, Wong Y, Nelson EA, Fok TF. Review of children hospitalised for ingestion and poisoning at a tertiary centre. Ann Acad Med Singap. 2005; 34:356–61.

14. Kweon YS, Hwang S, Yeon B, Choi KH, Oh Y, Lee HK, et al. Characteristics of drug overdose in young suicide attempters. Clin Psychopharmacol Neurosci. 2012; 10:180–4.

15. Mazer M, Perrone J. Acetaminophen-induced nephrotoxicity: pathophysiology, clinical manifestations, and management. J Med Toxicol. 2008; 4:2–6.

16. Schmidt LE. Age and paracetamol self-poisoning. Gut. 2005; 54:686–90.

17. Smilkstein MJ, Knapp GL, Kulig KW, Rumack BH. Efficacy of oral N-acetylcysteine in the treatment of acetaminophen overdose. Analysis of the national multicenter study (1976 to 1985). N Engl J Med. 1988; 319:1557–62.