engleski

Intravenous acetaminophen overdose: a case report of therapeutic error

Intravenous acetaminophen, as a 10 mg/ml solution, is commonly used as an analgesic and antipyretic when oral administration in not possible, especially in hospital settings. Unintentional overdose, error in dose calculation and therapeutic error often occur and can cause acute hepatic injury. We present the case of an 8-month- old female infant, weighing 7 kg, with numerous comorbidities, who was admitted to the Department of Nephrology of the Children’s Hospital Zagreb for a urinary tract infection. Due to clinical deterioration she underwent a central venous catheter placement. After the procedure she had high fever and, as antipyretic, 100 ml intravenous acetaminophen solution was administered. Shortly thereafter she became hypothermic and the nurse admitted making a therapeutic error - instead of 100 mg of acetaminophen, she administered 100 mL of intravenous acetaminophen solution, thus administering 1000 mg (142 mg/kg). Four hours after the administration serum acetaminophen concentration was 465 μg/mL. She was transferred to the intensive care unit and intravenous N- acetylcysteine (NAC) therapy was started immediately, following the 21-hour NAC protocol. Blood tests (liver and kidney functions, ammonia, prothrombin time, blood gas analysis) were performed daily and all values were in the normal range. The infant remained well and without hepatic impairment. The treatment of NAC infusion over 21 hours was efficacious. Caution should be exercised when prescribing and administering the drug to avoid dosing errors caused by confusion between milligrams (mg) and milliliters (ml), which may lead to accidental overdose and death. When prescribing the drug, it is necessary to indicate the total dose in mg and the total dose in volume in ml. Care should be taken to ensure that the dose is properly measured and administered.

accidental overdose ; hepatic injury ; infant ; intravenous administration ; N-acetylcysteine

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