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Lia Mano1, Antonio Pedro Campos2, Flora Candeias1, Maria João Brito1

1- Unidade de Infecciologia, Área de Pediatria Médica, Hospital Dona Estefânia, Centro Hospitalar Lisboa Central EPE, Lisboa
2- Unidade de Gastroenterologia, Área de Pediatria Médica, Hospital Dona Estefânia, Centro Hospitalar Lisboa Central EPE, Lisboa

- 7th Excellence in Pediatrics Conference, Londres, 10-12 Dezembro de 2015 (Comunicação Oral)

Introduction:  Acetaminophen is one of the most frequently used analgesics and antipyretic agents. However, the easy access to this medication and the population`s unawareness of its toxic effects have contributed to a rise in the number of intoxications. While acute toxicity occur mostly from intentional overdosis, chronic acetaminophen toxicity is attributable to unintended inappropriate dosing. There is lack of consensus on the management of paracetamol chronic overdosis.
Case report:  A 8-year-old girl with chickenpox, was medicatied with desloratadine, caladryl® and acetaminophen in supratherapeutic dosis - 120 mg/kg/day in the previous 24h and 80 mg/kg/day in the 4 days before, with a median diary dosis in the 72 hours preceding the interment, superior to 100 mg/kg/day. On the sixth day of illness she presented multiple infected vesiculous lesions with impetigo and was treated with flucloxacilin. Analysis revealed 3800 leucocytes/ml, neutrophils 62.3% and 130000 platelets; PCR 27,2g/L, PT 12,9seconds and apTT34 seconds, AST 84UI; ALT 102UI and GGT50UI. Urea, creatinine and ionogram were normal. Acetaminophen in the blood was 14 ug/ml. Accordingly to the protocol of our hospital, since she received multiple dosis superior to >75 mg/kg/day, she was administered a perfusion of N-acetilcystein: three dosis in the first day (first dosis: 150 mg/kg diluted in 100ml of dextrose 5% in 1 hour; second dosis: 50 mg/kg in 250ml of dextrose 5% in 4 hours; third dosis: 100 mg/kg in 500ml of dextrose 5% in 16 hours) and 100 mg/kg during the following days, repeating analysis every 16 hours. Though the levels of seric acetaminophen became negative at day 2 of internment, perfusion was interrupted only at day 7, when normalization of hepatic proves was attained. The levels of acetaminophen in the blood became negative (<3 ug/ml) at day 2 and renal function was never effected.
Conclusions:  Chronic acetaminophen toxicity in levels superior to 100 mg/kg/day for 72hours preceding the internment resulted in asymptomatic elevation of transaminases in our patient, without any complications reported during her evolution. Since several protocols are approved for chronic acetaminophen toxicity in children, a better optimization is needed with elaboration of consensus.

Palavras-Chave: acetaminophen; toxicity; children; lack of consensus