Paracetamol Toxicity in a 5-Year-Old Child: A Case Report

Introduction: Paracetamol is the most common analgesic and antipyretic that is used in the hospital setting and as over the counter medication and is commonly preferred in pediatric patients. In pediatric population, the dosage error accounts for most cases of acetaminophen toxicity. Paracetamol poisoning may be as a single acute ingestion or as a result of the repeated use. Symptoms vary depending on the stage the patient is in. Serum ALT is routinely used in the diagnosis of hepatic injury following Paracetamol overdose. N-acetylcysteine (NAC) is used as an antidote for Paracetamol toxicity. The antidote helps in replenishing liver glutathione level, thereby increasing the safe detoxification of N-acetyl-p-benzoquinone imine, NAPQI. Case Presentation: We present the case of a five years old male child known to have Spastic Quadriplegic Cerebral Palsy with Epilepsy on regular medication. He was admitted in the hospital with complains of productive cough associated with difficulty in breathing and fevers. Clinically on admission he was ill looking, febrile T- 38.7℃, and pale, with lower limbs non pitting edema. His weight was 13.7 kgs, length of 105cm and his Body mass Index (BMI) was 12.4 kg/m². On his respiratory system examination he had nasal flaring, lower chest wall indrawing and bilateral basal crepitation more on the right lung. The diagnosis was Spastic Quadriplegic Cerebral Palsy with Aspiration Pneumonia. He was started on IV Cefriaxone 350 mg 12 hourly, IV Metronidazole 130 mg 8 hourly and Paracetamol suppository 250 mg 6 hourly. On the third day in the ward, he started developing jaundice and he had severe vomiting more than 5 episodes per day. He was also found to have elevated liver functions (ALT 1218 U/l, AST 197.2 U/l). Acute Liver Failure was suspected due to Paracetamol toxicity and we initiated N-acetyl-cysteine (NAC) 1900 mg orally through the nasogastric tube STAT, then continued with 1000 mg orally every 4 hours 31 doses along with multivitamin 2 mls orally once a day, high carbohydrate diet. On day 9, the liver functions had normalized, there was tinge of jaundice with no edema and the patient was discharged to come for Paediatric follow-up clinic. Conclusion: Paracetamol is a commonly used drug, especially among Paediatric patients with potential for overdose. Paracetamol poisoning can lead to liver failure with possible fatal development in children. Reversal of Paracetamol toxicity is dependent on early identification with early initiation of appropriate medication. We advocate for increased awareness among clinicians on the appropriate dosage of Paracetamol specific to the type and nutritional status of the individual.