Aim: To review paediatric exploratory ingestions of paracetamol presenting to Christchurch Hospital Emergency Department.
Method: A retrospective review of all paediatric patients presenting with paracetamol ingestion over a 12 month period.
Results: During the study period there were 88 paediatric presentations for possible toxic ingestions involving paracetamol and 85 of these were exploratory self-ingestion. The male to female ratio was 43:42 and the mean age was 35 months. Paracetamol suspension was ingested in 79/85 cases and tablets in 6/85. The mean four hour plasma level was 162 mumol/L and all levels were well below the possible toxic level (1300 mumol/L). There was very poor correlation between estimated dose ingested and plasma level.
Conclusion: Toxicity from paediatric exploratory ingestion of paracetamol is extremely rare. To reduce the potential for poisoning, bottles and prescriptions of paracetamol should have less than a total dose of 4 g. The authors recommend that unwitnessed exploratory ingestions of paracetamol in children require no treatment if the estimated maximum ingested dose is below 140 mg/kg. Above this dose, treatment is based on the result of a plasma paracetamol level drawn four hours after ingestion. Gastrointestinal decontamination should be reserved for the rare occasions of a definite witnessed ingestion of a dose exceeding 140 mg/kg.