Intoxicación por acetaminofén en pediatría: aproximación y manejo
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ene 24, 2012
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Resumen
El paracetamol (acetaminofén) es uno de los medicamentos más usados en niños gracias a su eficaz efecto analgésico y antipirético. Tiene un buen perfil de seguridad, pero la administración a dosis elevadas puede producir importante toxicidad con riesgo de desarrollar falla hepática aguda, cuyo pronóstico depende de forma importante del reconocimiento oportuno y del inicio temprano de medidas terapéuticas específicas.
El paracetamol (acetaminofén), es uno de los medicamentos más usados en niños, gracias a su eficaz efecto analgésico y antipirético. Tiene buen perfil de seguridad aunque en administración de altas dosis puede producir toxicidad con riesgo de desarrollar una falla hepática aguda. El pronóstico depende en gran manera del reconocimiento oportuno y pronta puesta en marcha de medidas terapéuticas específicas.
Keywords
acetaminofén, intoxicación, pediatría, Acetaminophen, toxicity, pediatric,
References
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2. Gunnell D, Murray V, Hawton K. Use of paracetamol (acetaminophen) for suicide and nonfatal poisoning: Worldwide patterns of use and misuse. Suicide Life Threat Behav. 2000;30:313-26.
3. American Academy of Pediatrics. Acetaminophen toxicity in children. Pediatrics. 2001;108:1020.
4. Alander SW, Dowd MD, Bratton SL, Kearns GL, et al. Pediatric acetaminophen overdose: Risk factors associated with hepatocellular injury. Arch Pediatr Adolesc Med. 2000;154:346-50.
5. Henretig FM, Selbst SM, Forrest C, Kearney TK, Orel H, Werner S, Williams TA, et al. Repeated acetaminophen overdosing causing hepatotoxicity in children. Clinical reports and literature review. Clin Pediatr (Phila). 1989;28:525-8.
6. Dart RC, Erdman AR, Olson KR, Christianson G, Manoguerra AS, Caravati EM, Wax PM, et al. Acetaminophen poisoning: anevidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2006;44:1-18.
7. Larson AM, Polson J, Fontana RJ, Davern TJ, Lalani E, Hynan LS, Reish JS, et al. Acetaminophen-induced acute liver failure: results of a United States multicenter, prospective study. Hepatology. 2005;42:1364-72.
8. Davern TJ, Timothy J, James LP, Hinson JA, Larson AM, Fontana RJ, Lalani E, Munoz S 2nd, et al. Measurement of serum acetaminophen-protein adducts in patients with acute liver failure. Gastroenterology. 2006;130:687-94.
9. Rumack, BH. Acetaminophen overdose in children and adolescents. Pediatr Clin North Am. 1986;33:691-701.
10. Daly F, Fountain J, Murray L, Graudins A, Buckley N. Guidelines for the management of paracetamol poisoning in Australia and New Zealand –explanation and elaboration. Med J Aust. 2008;188:296-301.
11. Corcoran GB, Mitchell JR, Vaishnav YN, Horning EC. Evidence that acetaminophen and N-hydroxyacetaminophen form a common arylating intermediate, Nacetyl-p-benzoquinoneimine. Mol Pharmacol. 1980;18:536.
12. Heard K. Acetylcysteine for acetaminophen poisoning. N Engl J Med.
2008;359:285-92.
13. Slattery JT, Wilson JM, Kalhorn TF, Nelson SD. Dose-dependent pharmacokinetics of acetaminophen: Evidence for glutathione depletion in humans. Clin Pharmacol Ther. 1987;41:413.
14. Lauterburg BH, Vélez ME. Glutathione deficiency in alcoholics: Risk factor for paracetamol hepatotoxicity. Gut. 1988;29:1153-7.
15. Zenger F, Russmann S, Junker E, Wüthrich C, Bui MH, Lauterburg BH et al. Decreased glutathione in patients with anorexia nervosa. Risk factor for toxic liver injury? Eur J Clin Nutr. 2004;58:238-43.
16. Kurtovic J, Riordan SM. Paracetamolinduced hepatotoxicity at recommended dosage. J Intern Med. 2003;253:240-3.
17. Rowden AK, Norvell J, Eldridge DL, Kirk MA. Acetaminophen poisoning. Clin Lab Med. 2006;26:49-65.
18. Rodríguez A, Rodríguez O, Riera R, Rodríguez E, Del Pozo C, Torres JA, et al. Manual de toxicología clínica. Santiago de Cuba: Centro Provincial de Información de Ciencias Médicas (CPICMSC); 2004;64-8.
19. Davenport A, Finn R. Paracetamol (acetaminophen) poisoning resulting in acute renal failure without hepatic coma. Nephron. 1988;50:55.
20. Mathew J, Hines JE, James OFW, Burt AD. Non-parenchymal cell responses in paracetamol (acetaminophen)-induced liver injury. J Hepatol. 1994;20:537.
21. Anker AL, Smilkstein MJ. Acetaminophen: Concepts and controversies. Med Clin North Am. 1994;12:335.
22. Marx J, Adams J, Walls R. Rosen’s emergency medicine: Concepts and clinical practice. Sixth edition. Philadelphia, Elsevier. Cap. 146. 2006.
23. Mahadevan S, McKiernan PJ, Davies P, Kelly DA. Paracetamol induced hepatotoxicity. Arch Dis Child. 2006;91:598-603.
24. O’Grady JG, Alexander GJ, Hayllar KM, Williams R, et al. Early indicators of prognosis in fulminant hepatic failure. Gastroenterology. 1989;97:439-45.
25. Rose SR, Gorman RL, Oderda GM, Klein-Schwartz W, Watson WA (no hay más autores), et al. Simulated acetaminophen overdose: Pharmacokinetics and effectiveness of activated charcoal. Ann Emerg Med. 1991;20(10):1064.
26. Erickson TB, Trevonne M, Thompson, Jenny J. The approach to the patient with an unknown overdose. Emerg Med Clin North Am. 2007;25:249-81.
27. Harrison PM, Wendon JA, Gimson AES, Alexander GJM, Williams R. Improvement by acetylcysteine of hemodynamics and oxygen transport in fulminant hepatic failure. N Engl J Med. 1991;324:1852-7.
28. Martin J, Smilkstein MJ, Gary L, Knapp GL, Kenneth W, Kulig KW, Rumack BH, et al. Efficacy of oral N-acetylcysteine in the treatment of acetaminophen overdose. Analysis of the national multicenter study (1976 to 1985). N Engl J Med. 1988;319:1557-62.
29. Rumack BH. Acetaminophen hepatotoxicity: The first 35 years. J Toxicol Clin Toxicol. 2002;40:3-20.
30. Heard K. Acetylcysteine for acetaminophen poisoning. N Engl J Med.
2008;359:3.
31. Smollin C. Toxicology: Pearls and pitfalls in the use of antidotes. Emerg Med Clin North Am. 2010;28:149.
32. Smilkstein MJ, Knapp GL, Kulig KW, Rumack BH. Efficacy of oral N-acetylcysteine in the treatment of acetaminophen overdose: Analysis of the national multicenter study (1976 to1985). N Engl J Med. 1988;319:1557-62.
33. Smilkstein MJ, Bronstein AC, Linden C, Augenstein WL, Kulig KW, Rumack BH et al. Acetaminophen overdose: A 48-hour intravenous N-acetylcysteine treatment protocol. Ann Emerg Med. 1991;20:1058.
34. Alander SW, Dowd MD, Bratton SL, Kearns GL (no hay más autores) et al. Pediatric acetaminophen overdose: Risk factors associated with hepatocellular injury. Arch Pediatr Adolesc Med. 2000;154(4):346-50.
35. Mahadevan S, McKiernan P, Davies P, Kelly D. Paracetamol induced hepatotoxicity. Arch Dis Child. 2006;91:598-603.
2. Gunnell D, Murray V, Hawton K. Use of paracetamol (acetaminophen) for suicide and nonfatal poisoning: Worldwide patterns of use and misuse. Suicide Life Threat Behav. 2000;30:313-26.
3. American Academy of Pediatrics. Acetaminophen toxicity in children. Pediatrics. 2001;108:1020.
4. Alander SW, Dowd MD, Bratton SL, Kearns GL, et al. Pediatric acetaminophen overdose: Risk factors associated with hepatocellular injury. Arch Pediatr Adolesc Med. 2000;154:346-50.
5. Henretig FM, Selbst SM, Forrest C, Kearney TK, Orel H, Werner S, Williams TA, et al. Repeated acetaminophen overdosing causing hepatotoxicity in children. Clinical reports and literature review. Clin Pediatr (Phila). 1989;28:525-8.
6. Dart RC, Erdman AR, Olson KR, Christianson G, Manoguerra AS, Caravati EM, Wax PM, et al. Acetaminophen poisoning: anevidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2006;44:1-18.
7. Larson AM, Polson J, Fontana RJ, Davern TJ, Lalani E, Hynan LS, Reish JS, et al. Acetaminophen-induced acute liver failure: results of a United States multicenter, prospective study. Hepatology. 2005;42:1364-72.
8. Davern TJ, Timothy J, James LP, Hinson JA, Larson AM, Fontana RJ, Lalani E, Munoz S 2nd, et al. Measurement of serum acetaminophen-protein adducts in patients with acute liver failure. Gastroenterology. 2006;130:687-94.
9. Rumack, BH. Acetaminophen overdose in children and adolescents. Pediatr Clin North Am. 1986;33:691-701.
10. Daly F, Fountain J, Murray L, Graudins A, Buckley N. Guidelines for the management of paracetamol poisoning in Australia and New Zealand –explanation and elaboration. Med J Aust. 2008;188:296-301.
11. Corcoran GB, Mitchell JR, Vaishnav YN, Horning EC. Evidence that acetaminophen and N-hydroxyacetaminophen form a common arylating intermediate, Nacetyl-p-benzoquinoneimine. Mol Pharmacol. 1980;18:536.
12. Heard K. Acetylcysteine for acetaminophen poisoning. N Engl J Med.
2008;359:285-92.
13. Slattery JT, Wilson JM, Kalhorn TF, Nelson SD. Dose-dependent pharmacokinetics of acetaminophen: Evidence for glutathione depletion in humans. Clin Pharmacol Ther. 1987;41:413.
14. Lauterburg BH, Vélez ME. Glutathione deficiency in alcoholics: Risk factor for paracetamol hepatotoxicity. Gut. 1988;29:1153-7.
15. Zenger F, Russmann S, Junker E, Wüthrich C, Bui MH, Lauterburg BH et al. Decreased glutathione in patients with anorexia nervosa. Risk factor for toxic liver injury? Eur J Clin Nutr. 2004;58:238-43.
16. Kurtovic J, Riordan SM. Paracetamolinduced hepatotoxicity at recommended dosage. J Intern Med. 2003;253:240-3.
17. Rowden AK, Norvell J, Eldridge DL, Kirk MA. Acetaminophen poisoning. Clin Lab Med. 2006;26:49-65.
18. Rodríguez A, Rodríguez O, Riera R, Rodríguez E, Del Pozo C, Torres JA, et al. Manual de toxicología clínica. Santiago de Cuba: Centro Provincial de Información de Ciencias Médicas (CPICMSC); 2004;64-8.
19. Davenport A, Finn R. Paracetamol (acetaminophen) poisoning resulting in acute renal failure without hepatic coma. Nephron. 1988;50:55.
20. Mathew J, Hines JE, James OFW, Burt AD. Non-parenchymal cell responses in paracetamol (acetaminophen)-induced liver injury. J Hepatol. 1994;20:537.
21. Anker AL, Smilkstein MJ. Acetaminophen: Concepts and controversies. Med Clin North Am. 1994;12:335.
22. Marx J, Adams J, Walls R. Rosen’s emergency medicine: Concepts and clinical practice. Sixth edition. Philadelphia, Elsevier. Cap. 146. 2006.
23. Mahadevan S, McKiernan PJ, Davies P, Kelly DA. Paracetamol induced hepatotoxicity. Arch Dis Child. 2006;91:598-603.
24. O’Grady JG, Alexander GJ, Hayllar KM, Williams R, et al. Early indicators of prognosis in fulminant hepatic failure. Gastroenterology. 1989;97:439-45.
25. Rose SR, Gorman RL, Oderda GM, Klein-Schwartz W, Watson WA (no hay más autores), et al. Simulated acetaminophen overdose: Pharmacokinetics and effectiveness of activated charcoal. Ann Emerg Med. 1991;20(10):1064.
26. Erickson TB, Trevonne M, Thompson, Jenny J. The approach to the patient with an unknown overdose. Emerg Med Clin North Am. 2007;25:249-81.
27. Harrison PM, Wendon JA, Gimson AES, Alexander GJM, Williams R. Improvement by acetylcysteine of hemodynamics and oxygen transport in fulminant hepatic failure. N Engl J Med. 1991;324:1852-7.
28. Martin J, Smilkstein MJ, Gary L, Knapp GL, Kenneth W, Kulig KW, Rumack BH, et al. Efficacy of oral N-acetylcysteine in the treatment of acetaminophen overdose. Analysis of the national multicenter study (1976 to 1985). N Engl J Med. 1988;319:1557-62.
29. Rumack BH. Acetaminophen hepatotoxicity: The first 35 years. J Toxicol Clin Toxicol. 2002;40:3-20.
30. Heard K. Acetylcysteine for acetaminophen poisoning. N Engl J Med.
2008;359:3.
31. Smollin C. Toxicology: Pearls and pitfalls in the use of antidotes. Emerg Med Clin North Am. 2010;28:149.
32. Smilkstein MJ, Knapp GL, Kulig KW, Rumack BH. Efficacy of oral N-acetylcysteine in the treatment of acetaminophen overdose: Analysis of the national multicenter study (1976 to1985). N Engl J Med. 1988;319:1557-62.
33. Smilkstein MJ, Bronstein AC, Linden C, Augenstein WL, Kulig KW, Rumack BH et al. Acetaminophen overdose: A 48-hour intravenous N-acetylcysteine treatment protocol. Ann Emerg Med. 1991;20:1058.
34. Alander SW, Dowd MD, Bratton SL, Kearns GL (no hay más autores) et al. Pediatric acetaminophen overdose: Risk factors associated with hepatocellular injury. Arch Pediatr Adolesc Med. 2000;154(4):346-50.
35. Mahadevan S, McKiernan P, Davies P, Kelly D. Paracetamol induced hepatotoxicity. Arch Dis Child. 2006;91:598-603.
Cómo citar
Roldán, T., & López, Ángelo. (2012). Intoxicación por acetaminofén en pediatría: aproximación y manejo. Universitas Medica, 53(1), 56–67. https://doi.org/10.11144/Javeriana.umed53-1.iapa
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