Paracetamol poisoning in adolescents in an Australian setting: not quite adults

OBJECTIVE: To describe and compare the characteristics of paracetamol poisoning in adolescent and adult patients. METHOD: Descriptive retrospective case series of adolescent (12-17 years) and adult (>18 years) patients presenting to a metropolitan hospital network ED, diagnosed with paracetamol poisoning from October 2009 to September 2013. RESULTS: There were 220 adolescent (median age 16 years, 47 treated with acetylcysteine [NAC]) and 647 adult presentations (median age 27 years, 42 treated with NAC) for paracetamol poisoning in the study period. Adolescent patients were more frequently women (89 vs 76 ; odds ratio [OR] 2.4; 95 confidence interval [CI] 1.5-3.8) and ingested similar amounts of paracetamol (18 g) when requiring NAC treatment. Adolescents were more likely to ingest paracetamol as a single agent (53 vs 34 ; OR 2.2; 95 CI 1.6-3.0) and less likely to ingest compound paracetamol products than adults (18 vs 29 ; OR 0.54; 95 CI 0.36-0.79). Adolescents were less likely to report accidental supratherapeutic ingestion of paracetamol (0.02 vs 10 ; OR 0.23; 95 CI 0.09-0.58), or co-ingestion of prescription medications (25 vs 43 ; OR 0.4; 95 CI 0.31-0.62). Adolescents had more frequent histamine release reactions to NAC than adults (17 vs 8 ; OR 2.3; 95 CI 1.2-4.5). No cases required liver transplantation or resulted in death. CONCLUSION: Adolescents ingested comparable amounts of paracetamol to adults, when presenting with deliberate self-poisoning. However, there were significant differences in co-ingested medications and the reason for ingestion of paracetamol. Histamine reactions to NAC were more common in adolescents; however, most were mild. Overall, outcome was favourable in both cohorts.