How can paracetamol overdose damage children’s liver?
A single type of paracetamol with uniform strength must be given to everyone to avoid any confusion, say doctors as overdose is leading to liver damage
By Neelambaran A
Representational Image.
Hyderabad: Paracetamol overdose in children can be dangerous as it can lead to liver damage known as Paracetamol Induced Liver Disease (PILD). Parents often underestimate the strength of paracetamol medication prescribed and administer a higher strength to children. A widespread lack of awareness, along with similar packaging for all strengths of paracetamol, has been leading to many cases of overdose.
Experts are recommending that authorities adopt the method employed in Western and American countries, where a single type of paracetamol with uniform strength is given to everyone to avoid any confusion.
How different strengths of paracetamol pose a threat
Recently, a 16-month-old infant was given 5 ml of 500 mg paracetamol five times by the mother to treat fever, instead of 5 ml of 120 mg. This resulted in a severe overdose for the child and required admission to the intensive care unit.
Dr Sivarajani Santosh, senior paediatrician at Magna Centre, Hyderabad, said, “Paracetamol overdose in children has become a common occurrence which can endanger their lives. There are paracetamol suspensions available of different strengths like 1 ml containing 100 mg, 5 ml containing 120 mg, 125 mg, 240 mg, 250 mg and 500 mg.”
In this case, the mother gave 5 ml containing 500 mg to the infant, which is four times the normal amount, leading to an overdose. The child suffered from an acute liver failure, with stage 3 encephalopathy and went through dialysis and was on ventilation before recovering.
“The child’s liver was affected, and the child was admitted. In some cases, an overdose can push the child into a semi-coma state,” Dr Sivaranjani said.
Campaign for single-strength paracetamol
After several such incidents of paracetamol overdose, primarily due to a lack of awareness of the different strengths of paracetamols in the market, Dr Sivaranjani has initiated a signature campaign for a single-strength paracetamol.
“In western countries like the US, single-strength paracetamol is available, which avoids confusion. There, infants are given using a syringe while adults are given cups for measurement, which also prevents overdose,” she said.
How can single-strength paracetamol save lives?
A single strength paracetamol can avoid overdose and mishaps in children. If a single-strength paracetamol is available in the Indian market, the dosage of the medicine changes as per the age of the children. At present, various strengths of paracetamol are causing confusion among parents and pharmacists occasionally.
“Most parents do not go through the strength of paracetamol prescribed, and they purchase it. This results in overdose if a parent purchases 5 ml containing 500 mg paracetamol instead of 5 ml containing 120 mg of paracetamol,” Dr Sivaranjani said.
Until recently, the US had two strengths of paracetamol and countries like the UK still have different strengths of paracetamol. But the parents are aware of the different strengths and ensure that an overdose doesn’t happen.
Referring to the recent incident of overdose, the petition requests that the Central Drugs Standard Control Organisation (CDSCO) implement single-strength paracetamol.
“If we have a single strength of Paracetamol available like in most western countries, these dangerous mistakes can be prevented! It is extremely important that CDSCO takes cognisance of this fact and enforces only one strength of paracetamol suspension to be available in India,” the petition reads.
Increasing paracetamol market
As per the report of ChemAnalyst, the Indian market for pediatric paracetamol is around 41,000 tonnes in 2023. The market is expected to grow to 57,000 tonnes by 2034. The demand for pediatric paracetamol is increasing since it is generally used for pain relief and as an antipyretic for children.
Given the market size, the variety of strengths of paracetamol is bound to create confusion among parents and even pharmacists. Ensuring a single-strength pediatric paracetamol can avoid the confusion and protect children from accidental overdoses.
