![]() ![]() Nasogastric charcoal was administered, and intravenous fluids (10% dextrose) were begun. The paracetamol level was 121 mg/l four hours after ingestion, below the “150 treatment line” on the adult nomogram. At the time of the overdose, he was being fed with calorie supplemented breast milk and receiving multivitamins and iron.Īs soon as the overdose had been noticed, the stomach contents were aspirated no paracetamol was returned. He had mild hyaline membrane disease, transient asymptomatic neutropenia, phototherapy for jaundice (maximum bilirubin 119 mmol/l) for two days, and apnoea. He was symmetrically small for gestational age but had few problems of prematurity. The infant had been delivered at 29 weeks gestation weighing 740 g. ![]() He was otherwise well at the time of the overdose. The error was realised after four hours when the next dose was due. In error, a dose of 300 mg was given by nasogastric tube. Treatment includes N-acetylcysteine and supportive care, with activated charcoal for oral poisoning.Ī 2.2 kg, 55 day old male infant (corrected gestational age 37 weeks) was prescribed 30 mg (13.6 mg/kg) paracetamol before his first triple antigen immunisation. In an overdose, estimates of toxicity can be made from dose and Tβ in neonates, or from maternal toxicity in transplacental poisoning. The toxicity of paracetamol in neonates is unclear, but appears to be low because of slow oxidative metabolism and rapid glutathione synthesis. The increased plasma half life (Tβ) of 5.69 hours thus reflected normal slower metabolism in infants, rather than toxicity. After modelling of the data, the following pharmacokinetic variables were calculated: absorption half life (t abs), 0.51 hours volume of distribution (V/F oral), 0.80 litres/kg clearance (CL/F oral), 0.22 litres/h they were consistent with population pharmacokinetic studies. There was no biochemical evidence of hepatotoxicity, and no long term sequelae. Treatment was with activated charcoal, supportive care, and N-acetylcysteine. A 55 day old neonate, born 29 weeks premature, was accidentally given 136 mg/kg paracetamol. The first oral overdose of paracetamol in a neonate is reported. ![]()
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