Prospective evaluation of mild to moderate pediatric acetaminophen exposures

Study objective: To determine whether pediatric patients with acute, mild t o moderate acetaminophen exposures, treated with home monitoring alone, dev elop systemic signs of hepatic injury. Methods: A prospective, observational study of calls to a regional poison c enter over a 25-month period was performed. Patients were eligible for the study if they were younger than 7 years and had an acute maximum possible a cetaminophen exposure of up to 200 mg/kg. Exclusion criteria included previ ous decontamination measures, possibility of ingestion of an extended-relea se preparation, health or medication issues that could increase susceptibil ity to hepatotoxicity, current symptoms of hepatotoxicity, and indeterminab le ingestions. Study protocol included reviewing the signs and symptoms of early and late acetaminophen toxicity, a 4- to 6-hour follow-up call, and a 72-hour follow-up call. Outcome measures were defined as a verbal report b y the patient's parent or guardian of the presence or absence of signs or s ymptoms of hepatotoxicity. Results: A total of 1,039 patients were enrolled in the study, including 51 9 girls and 520 boys, with exposures ranging from 20 to 200 mg/kg. Eighteen patients were lost to follow-up; data were incomplete for 2 patients. At 7 2-hour follow-up, the remaining 1,019 patients were all doing well, without signs or symptoms of hepatotoxicity. Conclusion: On the basis of these data, pediatric patients with acute aceta minophen exposures of up to 200 mg/kg, treated with home monitoring alone, do not develop signs or symptoms of hepatic injury.