0-18 YAŞ ARASI ÇOCUKLARDA ASETAMİNOFEN ZEHİRLENMESİNİN RETROSPEKTİF OLARAK İNCELENMESİ

Abstract

Amaç: Asetaminofen, çocuklarda ateş düşürücü ve ağrı kesici olarak yaygın bir şekilde kullanılmaktadır. Asetaminofen zehirlenmesi, dünya genelinde en yaygın ilaç zehirlenmelerinden biridir. Buna rağmen, tedaviye yönelik hâlâ bir fikir birliği bulunmamaktadır. Bu çalışma, akut asetaminofen zehirlenmesi nedeniyle hastaneye yatırılan 0-18 yaş arasındaki pediyatrik hastaların klinik özelliklerini, laboratuvar bulgularını ve tedavi yaklaşımlarını değerlendirmeyi amaçlamaktadır. Yöntem: Bu çalışmada Ocak 2016-Ocak 2021 tarihleri arasında Kırşehir Eğitim ve Araştırma Hastanesi Acil Servisine asetaminofen alımı ile başvuran ve Çocuk Sağlığı ve Hastalıkları Servisine yatırılan 0-18 yaş arası çocukların dosyaları retrospektif olarak incelendi. Hastaların demografik özellikleri, asetaminofen alım nedeni, semptomları, laboratuvar bulguları ve tedavi süreçleri değerlendirildi. Verilerin analizinde tanımlayıcı istatistikler için sayı (n), yüzde (%), median ve çeyreklikler (Q1-Q3) kullanıldı. Bulgular: Ocak 2016-Ocak 2021 tarihleri arasında toplam 38 hasta asetaminofen zehirlenmesi ile başvurmuştur. Hastaların %36.8’i 0-5 yaş, %63.2’si 14-18 yaş grubundaydı. 5-14 yaş aralığında herhangi bir vaka tespit edilmedi. %63.2’si intihar amacıyla ilaç almış, intihar amacıyla ilaç alanların da %76’sı kadındı. Klinik semptomlar nadiren gözlenmiştir. Hastaların %73.7’sine aktif kömür, %68.2’sine mide lavajı, %23.7’sine NAC uygulanmıştır. ALT, AST ve protrombin zamanı median değerleri sırasıyla 15.24, 19.50 ve 12.60 olarak bulundu. Sonuç: Çalışmamız, küçük çocuklarda asetaminofen zehirlenmesinin genellikle kaza sonucu, ergenlerde ise intihar amacıyla meydana geldiğini göstermektedir. Kadın hastaların intihar amaçlı ilaç alım oranı daha yüksek bulundu. Sonuçlar literatürdeki benzer çalışmalarla uyumludur. Zehirlenmeleri önlemek için ebeveyn farkındalığının artırılmasına, ilaçların güvenli saklanmasına, erişimi kısıtlayan müdahalelere, risk altındaki bireylerin belirlenmesine yönelik çalışmalara ihtiyaç vardır.

Keywords

• Çocuk
• Asetaminofen Zehirlenmesi
• Retrospektif Çalışma

RETROSPECTIVE INVESTIGATION OF ACETAMINOPHEN POISONING IN CHILDREN AGED 0-18 YEARS

Abstract

Objective: Acetaminophen is widely used as an antipyretic and analgesic in children. Acetaminophen poisoning is one of the most common drug poisonings worldwide. Despite this, there is still no consensus on treatment. This study aims to evaluate the clinical characteristics, laboratory findings, and treatment approaches of pediatric patients aged 0-18 years who were hospitalized due to acute acetaminophen poisoning. Method: In this retrospective study, medical records of children aged 0-18 years who were admitted to the Emergency Department of Kırşehir Training and Research Hospital with acetaminophen ingestion and subsequently hospitalized in the Pediatric Health and Diseases Department between January 2016 and January 2021 were reviewed. Patients' demographic characteristics, reasons for acetaminophen intake, symptoms, laboratory findings, and treatment processes were analyzed. Descriptive statistics such as number (n), percentage (%), median, and quartiles (Q1-Q3) were used for data analysis. Results: Between January 2016 and January 2021, a total of 38 patients were admitted due to acetaminophen poisoning. Among them, 36.8% were aged 0-5 years, while 63.2% were in the 14-18 age group. There were no recorded cases in the 5-14 year age group. Clinical symptoms were rarely observed. A total of 63.2% of the cases involved suicidal ingestion, and 76% of these patients were female. Activated charcoal was administered to 73.7% of the patients, gastric lavage to 68.2%, and NAC to 23.7%. The median values for ALT, AST, and prothrombin time were 15.24, 19.50, and 12.60, respectively. Conclusion: Our study demonstrates that acetaminophen poisoning in young children is usually accidental, whereas in adolescents, it primarily occurs with suicidal intent. The rate of drug ingestion for suicidal purposes was higher among female patients. The results are consistent with similar studies in the literature. To prevent poisoning cases, increasing parental awareness, ensuring safe medication storage, implementing restricted access interventions, and identifying at-risk individuals are necessary.

Keywords

• Child
• Acetaminophen Poisoning
• Retrospective Study

References

1. Brune K, Renner B, Tiegs G. Acetaminophen/paracetamol: a history of errors, failures and false decisions. Eur J Pain. 2015;19(7):953-965.
2. WHO. WHO Model List of Essential Medicines-22nd List. Geneva: World Health Organization; 2021.
3. Australian Medicines Handbook Pty Ltd. Australian Medicines Handbook. Adelaide: Australian Medicines Handbook; 2020.
4. Penna A, Buchanan N. Paracetamol poisoning in children and hepatotoxicity. Br J Clin Pharmacol. 1991;32(2):143-149.
5. Sia J, Chan Y. Case Report: Paracetamol poisoning in a 2‐year‐old child-from international overview to the role of the Hong Kong Poison Information Centre. Hong Kong J Emerg Med. 2006;13(4):225-231.
6. Republic of Turkey Ministry of Health. Diagnostic and Treatment Guidelines for Primary Care. Ankara: Ministry of Health; 2012.
7. Jones AL, Dargan PI. What's new in toxicology? Curr Paediatr. 2001;11(6):409-413.
8. Shah AD, Wood DM, Dargan PI. Understanding lactic acidosis in paracetamol (acetaminophen) poisoning. Br J Clin Pharmacol. 2011;71(1):20-28.

9. Corcoran G, Mitchell JR, Vaishnav YN, Horning EC. Evidence that acetaminophen and N-hydroxyacetaminophen form a common arylating intermediate, N-acetyl-p-benzoquinoneimine. Mol Pharmacol. 1980;18(3):536-542.
10. Rivera-Penera T, Gugig R, Davis J, McDiarmid S, Vargas J, Rosenthal P, et al. Outcome of acetaminophen overdose in pediatric patients and factors contributing to hepatotoxicity. J Pediatr. 1997;130(2):300-304.
11. JL Green JL, Heard KJ, Reynolds KM, Albert D. Oral and intravenous acetylcysteine for treatment of acetaminophen toxicity: a systematic review and meta-analysis. West J Emerg Med. 2013;14(3):218-226.
12. Buckley N, Calear A, Cairns R, Reily N, Tang S, McCallum S, Christensen H. Independent expert report on the risks of intentional self-poisoning with paracetamol. Canberra: Therapeutic Goods Administration; 2022.Therapeutic Goods Administration; 2022.
13. Waring W, Jamie H, Leggett G. Delayed onset of acute renal failure after significant paracetamol overdose: a case series. Hum Exp Toxicol. 2010;29(1):63-68.
14. Eguia L, Materson BJ. Acetaminophen‐related acute renal failure without fulminant liver failure. Pharmacotherapy. 1997;17(2):363-370.
15. Chiew AL, Reith D, Pomerleau A, Wong A, Isoardi KZ, Soderstrom J, et al. Updated guidelines for the management of paracetamol poisoning in Australia and New Zealand. Med J Aust. 2020;212(4):175-183.
16. Wong A, Graudins A. Risk prediction of hepatotoxicity in paracetamol poisoning. Clin Toxicol (Phila). 2017;55(8):879-892.
17. Gloor Y, Schvartz D, Samer CF. Old problem, new solutions: biomarker discovery for acetaminophen liver toxicity. Expert Opin Drug Metab Toxicol. 2019;15(8):659-669.
18. Dear JW, Antoine DJ. Stratification of paracetamol overdose patients using new toxicity biomarkers: current candidates and future challenges. Expert Rev Clin Pharmacol. 2014;7(2):181-189.
19. Chiew AL, James, LP, Isbister GK, Pickering JW, McArdle K, Chan BS, et al. Early acetaminophen-protein adducts predict hepatotoxicity following overdose (ATOM-5). J Hepatol. 2020;72(3):450-462.
20. Bateman DN, Dear JW. Acetylcysteine in paracetamol poisoning: a perspective of 45 years of use. Toxicol Res (Camb). 2019;8(4):489-498.
21. Schmidt L, Dalhoff K. Risk factors in the development of adverse reactions to N‐acetylcysteine in patients with paracetamol poisoning. Br J Clin Pharmacol. 2001;51(1):87-91.
22. Heubi JE, Barbacci MB, Zimmerman HJ. Therapeutic misadventures with acetaminophen: hepatoxicity after multiple doses in children. J Pediatr. 1998;132(1):22-27.
23. Mund ME, Quarcoo D, Gyo C, Brüggmann D, Groneberg DA. Paracetamol as a toxic substance for children: aspects of legislation in selected countries. J Occup Med Toxicol. 2015;10:1-7.
24. Rakovcová H. Drug poisoning in children. Pediatrie Pro Praxi. 2013;14(2):126-129.
25. Ahmed A, AlJamal AN, Mohamed Ibrahim MI, Salameh K, AlYafei K, Zaineh SA, et al. Poisoning emergency visits among children: a 3-year retrospective study in Qatar. BMC Pediatr. 2015;15:1-7.
26. Koh SH, Tan KHB, Ganapathy S. Epidemiology of paediatric poisoning presenting to a children’s emergency department in Singapore over a five-year period. Singapore Med J. 2018;59(5):247-250.
27. Nistor N, Frasinariu OE, Rugina A, Ciomaga IM, Jitareanu C, Streanga V. Epidemiological study on accidental poisonings in children from northeast Romania. Medicine (Baltimore). 2018;97(29):e11469.
28. Zakharov S, Navratil T, Pelclova D. Non‐fatal suicidal self‐poisonings in children and adolescents over a 5‐year period (2007-2011). Basic Clin Pharmacol Toxicol. 2013;112(6):425-430.
29. Nguyen SN, Vu LT, Nguyen HT, Nguyen LMT. Childhood acute poisoning at Haiphong Children’s Hospital: a 10‐year retrospective study. Int J Pediatr. 2023;2023(1):2130755.
30. Marano M, Roversi M, Severini F, Memoli C, Musolino A, Pisani M, et al. Adverse drugs reactions to paracetamol and ibuprofen in children: a 5-year report from a pediatric poison control center in Italy. Ital J Pediatr. 2023;49(1):20.
31. Matalova P, Buchta M, Drietomska V, Spicakova A, Wawruch M, Ondra P, et al. Acute drug intoxication in childhood: a 10-year retrospective observational single-centre study and case reports. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2023;167(3):294-302.
32. Roversi M, Martini M, Musolino A, Pisani M, Zampini G, Genuini L, et al. Drug self-poisoning in adolescents: a report of 267 cases. Toxicol Rep. 2023;10:680-685.
33. Shadman KA, Edmonson MB, Coller RJ, Sklansky DJ, Nacht CL, Zhao Q, et al. US hospital stays in children and adolescents with acetaminophen poisoning. Hosp Pediatr. 2022;12(2):e60-e67.
34. Shekunov J, Lewis CP, Vande Voort JL, Bostwick JM, Romanowicz M. Clinical characteristics, outcomes, disposition, and acute care of children and adolescents treated for acetaminophen toxicity. Psychiatr Serv. 2021;72(7):758-765.