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WNPU publication – inadvertent paediatric IV paracetamol poisoning

27 March 2024

Congratulations to Director of the Welsh National Poisons Unit Dr. Laurence Gray whose paper titled “Medication errors involving intravenous paracetamol in children: experience from enquiries to the National Poisons Information Service” (NPIS) was successfully published in the BMJ journal Archives of Disease in Childhood in January 2024.

The paper was a collaboration with Dr. Florence Vincent from the Royal Free Hospital, London, Dr. David Tuthill from the Noah’s Ark Children’s Hospital for Wales and fellow directors of NPIS units in Birmingham, Edinburgh and Newcastle. This paper provides the first piece of national UK data focusing on the issue of accidental paediatric IV paracetamol poisoning, using information from telephone enquiries made to the NPIS between 2008 and 2021. See abstract summary below:


Introduction Children are at higher risk of medication errors due to the complexity of drug prescribing and administration in this patient group. Intravenous (IV) paracetamol overdose differs from overdose by ingestion as there is no enteral absorptive buffering. We provide the first national UK data focusing on paediatric IV paracetamol poisoning.

Methods All telephone enquiries to the National Poisons Information Service between 2008 and 2021 regarding children less than 18 years old in the UK concerning IV paracetamol overdose were extracted from the UK Poisons Information Database (UKPID). Data were analysed using descriptive statistics.

Results Enquiries were made concerning 266 children, mostly involving children under the age of 1 year (n=145; 54.5%). Acute and staggered overdoses were the most frequent types of exposure. Common error themes included 10-fold overdose in 45 cases (16.9%) and inadvertent concomitant oral and IV dosing in 64 cases (24.1%). A high proportion of cases were asymptomatic (87.1%), with many calls regarding overdoses below the treatable dose of 60 mg/kg (41.4%). Treatment with the antidote acetylcysteine was advised in 113 cases (42.5%).

Conclusions Inadvertent IV paracetamol overdose appears to occur more frequently in young children. A significant proportion were calculation errors which were often 10-fold errors. While these errors have the potential for causing serious harm, thankfully most cases were asymptomatic. Errors with IV paracetamol might be reduced by electronic prescribing support systems, better communication regarding administration and consideration of whether other routes are more appropriate.

To read the full paper, please click here.

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