Health: Caution needed with paracetamol dosage

BRISBANE - Even low doses of paracetamol over several days may cause liver failure in some children.

A review of the medical records of 18 children admitted to Sydney's Royal Alexandra Hospital with liver failure found it was caused by accidental overdoses of paracetamol in eight cases.

Paracetamol was implicated in a further three cases, the researchers found.

Fiona Miles, fellow in intensive care, and colleagues, says in an article in the Medical Journal of Australia that the eight children received paracetamol for four to 21 days before developing liver disease.

The intake ranged from 20 to 200mg per kilogram a day.

Information supplied with paracetamol recommends a maximum daily dose of 60mg per kilogram.

"In our study, reported ingestion of as little as 20mg per kilogram a day over a protracted period was associated with liver failure," says Fiona Miles.

"Similar toxic dosage ranges have been reported in other studies of children, raising the question of whether some susceptible children could suffer acute liver failure as a result of therapeutic doses of paracetamol ingested over several days."

But the authors stress that the intake noted on medical records is that reported by parents and cannot not be verified.

In the same journal, paediatricians from Melbourne's Royal Children's Hospital warn that while harm from paracetamol is generally regarded as unlikely at doses below 150mg per kilogram a day, there is increasing evidence of the potential for liver toxicity in children given multiple therapeutic doses.

It is not uncommon for children to receive doses in excess of 90mg per kilogram a day in hospital, say Jenny Hynson and Professor Mike South.

The two caution that paracetamol should be administered with caution and according to dosage guidelines.
- NZPA