Nephrotoxicity after acute severe acetaminophen poisoning in adolescents

Objective: To determine the rate of acetaminophen related nephrotoxicity in adolescents who present after acute severe acetaminophen intoxication and to identify potential predictors of this outcome. Study Design: Retrospecti ve analysis of consecutive patients between the ages of 12 and 18 years who were admitted at a tertiary care children's hospital for treatment of acut e severe acetaminophen intoxication with N-acetylcysteine. The main outcome measure was the frequency of acetaminophen-related nephrotoxicity, defined as abnormal blood urea nitrogen (>6.4 mmol/L or > 18 mg/dL) and/or elevate d creatinine (97.2 mu mol/L or >1.1 mg/dL) in association with one or both of the following: elevated blood pressure (systolic blood pressure > 140 mm Hg/diastolic blood pressure > 85) or abnormal urinalysis (urinalysis with hematuria or proteinuria). Statistical analyses used were measures of centr al tendency, Student's t-test, Mann-Whitney, and multivariate logistic regr ession. Results: Fourty-five patients were included. Acetaminophen-related nephrotoxicity occurred in 4 (8.9%) cases. One victim developed severe rena l injury in association with elevated hepatic transaminases. Intergroup ana lyses revealed no statistically significant association between acetaminoph en-related nephrotoxicity and amount/kg of acute severe acetaminophen inges ted, delay in treatment with N-acetylcysteine, or measures of hepatic funct ion. Conclusions: Acetaminophen-related nephrotoxicity occurred in 8.9% [95 % CI: 4.52, 20.48] of children with severe overdose. There are no obvious p redictors of this complication of acetaminophen overdose. Because the occur rence of renal injury can not be predicted, serial blood pressure, blood ur ea nitrogen/creatinine, and urinalysis should be considered an integral par t of the management of children with acute, severe acetaminophen intoxicati on.