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Risk Factors for Hepatocellular Injury in Pediatric Acetaminophen Overdose

Purpose: To identify a pediatric patient at risk for hepatocellular injury after an acetaminophen overdose.

Description

Alander et al identified risk factors for hepatocellular injury in pediatric patients with an acetaminophen overdose. This can help identify patients who may benefit from closer monitoring and more aggressive management. The authors are from Children's Mercy Hospital in Kansas City, University of Washington and Seattle Children's Hospital.


 

Patient selection: pediatric patients from 1 to 17 years of age

 

Hepatocellular injury was defined as an elevation of AST and/or ALT > 2 times the upper limit of the reference range.

 

Severe hepatocellular injury is defined by the presence of one or both of the following:

(1) encephalopathy and/or

(2) coagulopathy.

 

Risk factors for hepatocellular injury:

(1) age 10 to 17 years

(2) presentation > 24 hours after ingestion

(3) dose > 150 mg/kg

(4) intentional overdosage

(5) Caucasian race

Risk Factor

Odds Ratio

age 10-17 years

36.9

delayed presentation

335

dose > 150 mg/kg

17.9

intentional overdose

37.2

Caucasian

2.8

 

where:

• Overdose due to dosing error was usually seen in young children.

 


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Specialty

Objective

ICD-10