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There was a nice article published last month in J Pediatr summarizing
47 cases
of hepatotoxictiy from therapeutic acetaminophen. I have a brief review
of it and
the citation on my website-
http://www.pediatric-emergency.com
 
Jay Fisher MD
 
 
 
Jay Pershad, M.D. wrote:
 
> Couple of comments:
>
> 1. Simply doubling the total daily therapeutic dose of acetaminophen,
> whether PO or PR route for more than 48 hours has been shown to
> produce
> hepatotoxicity. [ > 140 mg/kg/day]. A one time dose is probably going
> to
> be OK but not on a "round the clock" basis.
>
> 2. I think fever is not a bad thing unless the patient is prone to
> febrile seizures and we as providers should not feed into this "fever
> phobia" that exists out there by over-emphasizing antipyretics & fever
>
> control.
>
> 3. The analgesic nephropathy[interstitial nephritis] was more of an
> issue I thought with chronic dosing with "tylenol with codeine" in the
>
> NEJM article and not regular acetaminophen.
>
> Thanks
>
> Jay Pershad
>
> > -----Original Message-----
> > From: Mark Hostetler [SMTP:[log in to unmask]]
> > Sent: Thursday, February 19, 1998 6:09 PM
> > To:   Multiple recipients of list PED-EM-L
> > Subject:      Rectal Tylenol
> >
> > Are there any group thoughts on rectal tylenol at the higher dose
> > ranges
> > of 30-40mg/kg?
> > Specifically regarding frequency, or infrequency, at these higher
> > doses?
> >
> > As with many others we are deluged with kids with extremely high
> temps
> > (41.8'C) - I wonder regarding the pros (higher serum levels -
> perhaps
> > at
> > "therapeutic levels") and cons of those higher doses (?hepatic
> > consequences, chronic toxicity).
> >
> > Mark Hostetler
> >
> > For more information, send mail to [log in to unmask] with
> the
> > message: info PED-EM-L
> > The URL for the PED-EM-L Web Page is:
> >
> http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html
>
> For more information, send mail to [log in to unmask] with the
> message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>   http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html
 
For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
  http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html