What should be done if a 6-year-old child has ingested a dozen Panadol (Paracetamol) tablets?

From the Guidelines

If a 6-year-old child has ingested a dozen Panadol (Paracetamol) tablets, immediate medical attention is crucial, and the child should be taken to the nearest emergency room or emergency services should be called right away. While waiting for help, do not induce vomiting unless specifically instructed by a medical professional. Try to determine exactly how many tablets were taken, the strength (typically 500mg per tablet for adult Panadol), and when they were consumed. Bring the medication package to show medical staff. Paracetamol (acetaminophen), the active ingredient in Panadol, can cause severe liver damage in overdose, even if the child initially appears well.

Key Considerations

• The antidote N-acetylcysteine is most effective when given within 8 hours of ingestion, as recommended by the Annals of Emergency Medicine 1.
• This situation is particularly dangerous for a child because their smaller body size means toxic levels are reached with fewer tablets than in adults.
• The liver damage from paracetamol overdose can develop slowly over 24-48 hours, so prompt medical attention is essential even if the child seems fine initially.

Management Approach

• According to the AASLD position paper on the management of acute liver failure, NAC should be started promptly in all patients where the quantity of acetaminophen ingested, serum drug level, or rising aminotransferases indicate impending or evolving liver injury 1.
• The Rumack-Matthew nomogram can be used to determine the risk of hepatotoxicity, and NAC should be administered to patients with possible or probable risk for hepatotoxicity, as recommended by the Annals of Emergency Medicine 1.

Conclusion is not allowed, so the answer will be ended here.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION General Regardless of the quantity of acetaminophen reported to have been ingested, administer acetylcysteine solution immediately if 24 hours or less have elapsed from the reported time of ingestion of an overdose of acetaminophen. The stomach should be emptied promptly by lavage or by inducing emesis with syrup of ipecac.

1. The stomach should be emptied promptly by lavage or by inducing emesis with syrup of ipecac. Syrup of ipecac should be given in a dose of 15 mL for children up to age 12 and 30 mL for adolescents and adults followed immediately by drinking copious amounts of water.

The child should be given 15 mL of syrup of ipecac to induce emesis, followed by drinking copious amounts of water.

• The dose should be repeated if emesis does not occur in 20 minutes.
• Acetylcysteine solution should be administered immediately if 24 hours or less have elapsed from the reported time of ingestion of an overdose of acetaminophen. 2

From the Research

Immediate Action

• If a 6-year-old child has ingested a dozen Panadol (Paracetamol) tablets, it is essential to seek medical attention immediately 3, 4, 5.
• The child should be taken to the hospital or a poison control center as soon as possible.

Treatment

• The treatment of choice for paracetamol poisoning is N-acetylcysteine, a specific antidote that reduces paracetamol hepatotoxic effects 4, 5.
• N-Acetylcysteine should be given according to specific regimens through weight-based dosing tables 4.
• Administration of activated charcoal may also be considered to decrease the absorption of paracetamol 3, 5.

Clinical Course

• The clinical course of acetaminophen poisoning can be divided into four phases, which distinguish signs, symptoms, and laboratory values according to severity 5.
• The prognosis depends on the amount ingested and the time of presentation after ingestion 5.

Important Considerations

• Chronic alcoholics, binge drinkers, patients taking medications that induce the P-450 isoenzyme system, and those with concomitant liver disease are at higher risk of hepatotoxicity 5.
• Careful patient monitoring and personalization of post-overdose procedures are recommended, especially in newborns and infants who have received a single overdose and have paracetamol concentrations below the Rumack-Matthew nomogram limits 4.