Case reports
Paracetamol overdose in a preterm neonate
G K Isbistera, I K Bucensb, I M Whytec
a Royal Darwin
Hospital, Northern Territory, Australia, b Royal Darwin Hospital and Northern Territory
Clinical School, Flinders University, c Department of Clinical Toxicology and
Pharmacology, Newcastle Mater Misericordiae Hospital, Newcastle, NSW,
Australia
Correspondence to: Dr Isbister, Department of Clinical Toxicology and Pharmacology, Newcastle Mater Misericordiae Hospital, Locked Bag 7, Hunter Region Mail Centre, NSW 2310, Australia gsbite{at}bigpond.com
Accepted 21 February
2001
The first oral overdose of paracetamol in a neonate is
reported. A 55 day old neonate, born 29 weeks premature, was
accidentally given 136 mg/kg paracetamol. Treatment was with activated
charcoal, supportive care, and N-acetylcysteine. There was no
biochemical evidence of hepatotoxicity, and no long term sequelae.
After modelling of the data, the following pharmacokinetic variables
were calculated: absorption half life (tabs), 0.51 hours;
volume of distribution (V/Foral), 0.80 litres/kg; clearance
(CL/Foral), 0.22 litres/h; they were consistent with
population pharmacokinetic studies. The increased plasma half life
(T
) of 5.69 hours thus reflected normal slower metabolism in
infants, rather than toxicity. The toxicity of paracetamol in neonates
is unclear, but appears to be low because of slow oxidative metabolism
and rapid glutathione synthesis. In an overdose, estimates of toxicity
can be made from dose and T in neonates, or from maternal toxicity
in transplacental poisoning. Treatment includes N-acetylcysteine and
supportive care, with activated charcoal for oral poisoning.
Keywords: paracetamol; overdose; preterm; toxicity
© 2001 by Archives of Disease in Childhood
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This article has been cited by other articles:
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de la Pintiere, A, Beuchee, A, Betremieux, P E
(2003). Intravenous propacetamol overdose in a term newborn. Arch. Dis. Child. Fetal Neonatal Ed.
88: F351-F352
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