January 15, 2022

Dose to death: new study on paracetamol poisoning in New Zealand children

“It's devastating for them.  They feel like they're doing the right thing, ”said Helen Evans, Starship Hospital doctor, of parents who accidentally poison children with paracetamol.  (File photo)

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“It’s devastating for them. They feel like they’re doing the right thing, ”said Helen Evans, Starship Hospital doctor, of parents who accidentally poison children with paracetamol. (File photo)

A common pain reliever is sending a constant flow of New Zealand children on the waitlist for liver transplants and a new study is now expected to stem the tide.

The Health Research Council, Department of Health and ACC have awarded nearly $ 400,000 for the study to prevent paracetamol poisoning in children.

“Moms and dads think they’re doing the right thing by giving paracetamol,” said Helen Evans, children’s liver specialist at Starship Hospital. “It’s devastating for them.”

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Paracetamol, often given to sick children under the brand name Pamol, is hailed by healthcare professionals as an effective and generally safe medicine for pain and fever, but poorly dosed – especially over a long period – it can cause liver damage as well, in rare cases. but real situations, death.

The National Poisons Center (NPC) receives approximately 800 calls per year regarding the ingestion of paracetamol in children. Evans sees them when the worst happens: poisoning means hospitalization and, if not caught in time, the need for a liver transplant.

Evans was the author of a 2014 study, Acute liver failure associated with paracetamol in Australian and New Zealand children: high rate of medication errors, which found that in Queensland, Australia and New Zealand, 14 of 54 cases of acute failure were attributed to paracetamol. Twelve of the 14 cases were children under 5 years old. Three children underwent liver transplants and two died, including one who received a transplant

Parents give children paracetamol for pain and fever relief, but the wrong dosage - especially over a prolonged period - may require a liver transplant.

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Parents give children paracetamol for pain and fever relief, but the wrong dosage – especially over a prolonged period – may require a liver transplant.

Evans said there was nothing to suggest those numbers had changed. . Much of the problem was that paracetamol was available in different doses and strengths, which meant parents didn’t always get the right dosage. The problems were exacerbated by the already sick and dehydrated children.

“Some people need liver transplants. There is a risk that they will die if we can’t do it in time, ”Evans said.

But, if taken on time, full recovery was the usual result, she said.

“We’ve seen kids drink a whole bottle, but they’re okay because it’s just once. These are the repeated doses in sick children.

Parents give children paracetamol for pain and fever relief, but the wrong dosage - especially over a prolonged period - may require a liver transplant.  (File photo)

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Parents give children paracetamol for pain and fever relief, but the wrong dosage – especially over a prolonged period – may require a liver transplant. (File photo)

Education was the best medicine, especially for Maori and Pasifika parents, who were disproportionately more likely to overdose their children, she said.

Rawiri McKree Jansen, lead author of the two-year study on how to educate parents about the dangers of paracetamol, said nearly a third of the 804 annual calls to the poison control center were due to parents giving the wrong dose.

“This suggests to me that many more whānau have trouble dosing paracetamol accurately than the small number who end up in emergency departments,” he said.

More than half of all pediatric patients with acute liver failure in New Zealand children were Maori, he said.

His study – lasting two years but hopefully producing results within a year – looked at the challenges parents and caregivers face in accurately dosing paracetamol.

Dr Adam Pomerleau, clinical toxocologist and director of the NPC at the University of Otago, said it looked like the figure of 804 calls per year came from a 2014 article, but he believed the numbers would now be ” tied or more “.

“There is a good antidote, but it has to be given in a timely manner,” he said.


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