Paracetamol-associated acute liver failure in Australian and New Zealand children: high rate of medication errors

Rajanayagam, J
Bishop, J R
Lewindon, P J
Evans, Helen M

¹Department of Paediatric Gastroenterology, Hepatology and Nutrition, Starship Children's Hospital, Auckland, New Zealand
²Department of Paediatric Gastroenterology, Hepatology and Nutrition, Royal Children's Hospital, Brisbane, Australia

Correspondence to Dr J Rajanayagam, Department of Paediatric Gastroenterology, Hepatology & Nutrition, Starship Children's Hospital, Auckland 1023, New Zealand; [email protected]

Received 31 July 2013 Revised 2 August 2014; Accepted 5 August 2014; Published online January 16 September 2014

Contributors JRB and HME jointly conceived the study; JR designed the study, collected data, analysed data and wrote the paper; JRB, HME and PJL discussed the results and implications, commented and edited the manuscript at all stages.

Competing interests None.

Ethics approval Queensland Children's Health Services Human Research Ethics Committee.

Provenance and peer review Not commissioned; externally peer reviewed.

Acknowledgments The authors acknowledge the data contribution of the New Zealand National Poisons Centre and Queensland Poisons Information Centre. We thank Peter Reed and the Children's Research Centre, Starship Children's Hospital, New Zealand, for their assistance in data analysis. We acknowledge Dr J Khoosal for assistance with graphical art.

Archives of Disease in Childhood 100(1):p 77-80, January 2015. | DOI: 10.1136/archdischild-2013-304902

ABSTRACT

Background

In children, paracetamol overdose due to deliberate self-poisoning, accidental exposure or medication errors can lead to paediatric acute liver failure and death. In Australia and New Zealand, the nature of ingestion and outcomes of paracetamol-associated paediatric acute liver failure have not been described.

Objective

To describe the nature and outcomes of paracetamol-associated paediatric acute liver failure.

Design

Retrospective analysis of paracetamol-associated paediatric acute liver failure cases presenting 2002-2012.

Setting

New Zealand and Queensland Paediatric Liver Transplant Services.

Results

14 of 54 cases of paediatric acute liver failure were attributed to paracetamol, the majority were secondary to medication errors. 12 of the 14 children were under the age of 5 years. Seven children received doses in excess of 120 mg/kg/day. Many of the other children received either a double dose, too frequent administration, coadministration of other medicines containing paracetamol or regular paracetamol for up to 24 days. Three children underwent transplant. One of these and one other child died.

Conclusions

In Australia and New Zealand, paracetamol overdose secondary to medication errors is the leading cause of paediatric acute liver failure. A review of regional safety practices surrounding paracetamol use in children is indicated.