From the Guidelines
The toxic dose of Tylenol (acetaminophen) for children is generally considered to be more than 150 mg/kg as a single dose, and doses above 200 mg/kg are considered potentially fatal without prompt medical intervention. At this level, liver damage becomes a significant risk, and children are particularly vulnerable to acetaminophen toxicity due to their developing metabolic systems 1. If you suspect a child has ingested a toxic dose of Tylenol, seek emergency medical attention immediately - do not wait for symptoms to appear, as liver damage can occur before visible signs of toxicity.
Some key points to consider in the management of acetaminophen overdose in children include:
- Early symptoms of acetaminophen overdose include nausea, vomiting, and abdominal pain, while more serious signs of liver damage may not appear until 24-48 hours after ingestion 1.
- The safe therapeutic dose for children is 10-15 mg/kg every 4-6 hours, not exceeding 5 doses (75 mg/kg total) in 24 hours.
- Acetaminophen toxicity occurs because when taken in excessive amounts, the liver's normal detoxification pathways become overwhelmed, leading to the accumulation of a toxic metabolite that damages liver cells.
- Administration of N-acetylcysteine (NAC) is recommended in any case of acetaminophen overdose, and it should be given as early as possible, but may still be of value 48 hours or more after ingestion 1.
In terms of treatment, NAC may be given orally (140 mg/kg by mouth or nasogastric tube diluted to 5% solution, followed by 70 mg/kg by mouth q 4 h 17 doses) and has few side effects, or it may be administered intravenously (loading dose is 150 mg/kg in 5% dextrose over 15 minutes; maintenance dose is 50 mg/kg given over 4 hours followed by 100 mg/kg administered over 16 hours) 1. Allergic reactions may be successfully treated with discontinuation, antihistamines and epinephrine for bronchospasm.
From the Research
Toxic Dose of Tylenol in Children
- The toxic dose of Tylenol (acetaminophen) in children is a critical consideration in pediatric care 2.
- According to a study published in 2006, patients less than 6 years of age should be referred to an emergency department if the estimated acute ingestion amount is unknown or is 200 mg/kg or more 2.
- Another study published in 2014 found that doses of less than 75 mg/kg per day of acetaminophen are safe for children younger than 6 years 3.
- Key considerations for toxic doses of Tylenol in children include:
- Age of the child
- Estimated ingestion amount
- Time elapsed since ingestion
- Presence of signs consistent with acetaminophen poisoning (e.g., repeated vomiting, abdominal tenderness in the right upper quadrant or mental status changes) 2
- It is essential to note that these recommendations are based on specific studies and may not be applicable to all situations, highlighting the need for careful evaluation and consideration of individual cases 2, 3.