Hedeland et al identified factors associated with acetaminophen-induced hepatotoxicity in a pediatric patient. These can help to identify a patient who may benefit from more aggressive management. The authors are from Nordsjaellands Hospital and Rigshospitalet in Denmark.
Patient selection: pediatric patient with acetaminophen poisoning with maximal INR >= 1.5
Hepatotoxicity was graded based on maximal levels of INR and ALT.
Predictors of severe hepatotoxicity:
(1) >= 3 prehospital vomiting episodes
(2) time to initiation of N-acetylcysteine therapy > 12 hours
Biochemical manifestations may include:
(1) high serum creatinine concentrations (>= 75 µmol/L; associated with acetaminophen-induced nephrotoxicity)
(2) hypophosphatemia
(3) initial INR >= 1.3 (Figure 2)
(4) initial serum total bilirubin >= 15 µmol/L (Figure 2)
(5) elevated initial transaminases (AST and ALT)
The initial biochemical values might be affected by a delay in presentation as well as the severity of the hepatotoxicity.
The severity of the hepatotoxicity did not show a significant relationship with the amount of ingested acetaminophen.
