Pediatric Acetaminophen Toxicity Differential Diagnoses

  • Author: Germaine L Defendi, MD, MS, FAAP; Chief Editor: Timothy E Corden, MD   more...
 
Updated: Sep 23, 2011
 
 

Diagnostic Considerations

When evaluating a patient with suspected acetaminophen (APAP) toxicity, also consider other conditions that can cause acute hepatotoxicity or have a similar clinical presentation. The following conditions should be assessed as part of the differential diagnosis:

  • Alcoholic hepatitis
  • Drug-induced or toxin-induced hepatitis
  • Hepatobiliary disease
  • Inborn errors of metabolism, including alpha1-antitrypsin (AAT) deficiency or fatty acid oxidation abnormalities
  • Ischemic hepatitis (shock liver)
  • Reye syndrome
  • Viral hepatitis due to Epstein-Barr virus or varicella
  • Vomiting of unclear etiology

Differential Diagnoses

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

Germaine L Defendi, MD, MS, FAAP  Associate Clinical Professor, Department of Pediatrics, Olive View-UCLA Medical Center

Germaine L Defendi, MD, MS, FAAP is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Coauthor(s)

Jeffrey R Tucker, MD  Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, University of Connecticut School of Medicine, Connecticut Children's Medical Center

Disclosure: Merck Salary Employment

Specialty Editor Board

Halim Hennes, MD, MS  Division Director, Pediatric Emergency Medicine, University of Texas Southwestern Medical Center at Dallas, Southwestern Medical School; Director of Emergency Services, Children's Medical Center

Halim Hennes, MD, MS is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Jeffrey R Tucker, MD  Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, University of Connecticut School of Medicine, Connecticut Children's Medical Center

Disclosure: Merck Salary Employment

Chief Editor

Timothy E Corden, MD  Associate Professor of Pediatrics, Co-Director, Policy Core, Injury Research Center, Medical College of Wisconsin; Associate Director, PICU, Children's Hospital of Wisconsin

Timothy E Corden, MD is a member of the following medical societies: American Academy of Pediatrics, Phi Beta Kappa, Society of Critical Care Medicine, and Wisconsin Medical Society

Disclosure: Nothing to disclose.

References

  1. [Guideline] AAP. American Academy of Pediatrics. Committee on Drugs. Acetaminophen toxicity in children. Pediatrics. Oct 2001;108(4):1020-4. [Medline]. [Full Text].

  2. Anker AL, Smilkstein MJ. Acetaminophen. Concepts and controversies. Emerg Med Clin North Am. May 1994;12(2):335-49. [Medline].

  3. US Food and Drug Administration. Public health problem of liver injury related to the use of acetaminophen in both over-the-counter (OTC) and prescription (RX) products. Available at http://www.fda.gov/AdvisoryCommittees/Calendar/ucm143083.htm. Accessed August 5, 2009.

  4. Health and Human Services. Federal Register. 74(81). April 29, 2009. [Full Text].

  5. Department of Health and Human Services; Food and Drug Administration. Organ-Specific Warnings; Internal Analgesic, Antipyretic, and Antirheumatic Drug Products for Over-the-Counter Human Use; Final Monograph. Federal Register [serial online]. April 29, 2009;74:19385-409. Accessed March 30, 2010. Available at www.fda.gov.

  6. US Food and Drug Administration. Acetaminophen information. Available at http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm165107.htm. Accessed August 18, 2011.

  7. Acetaminophen and Liver Injury: Q & A for Consumers. FDA Consumer Health Information: US Food and Drug Administration; June 2009. 1-3. [Full Text].

  8. 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 to 1985). N Engl J Med. Dec 15 1988;319(24):1557-62. [Medline].

  9. Wolf SJ, Heard K, Sloan EP, Jagoda AS. Clinical policy: critical issues in the management of patients presenting to the emergency department with acetaminophen overdose. Ann Emerg Med. Sep 2007;50(3):292-313. [Medline].

  10. Mottram AR, Kumar AM. Focus On: Acetaminophen Toxicity and Treatment. American College of Emergency Physicians. Available at http://www.acep.org. Accessed July 21, 2009.

  11. Dart RC, Erdman AR, Olson KR, et al. Acetaminophen poisoning: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2006;44(1):1-18. [Medline].

  12. Farrell, SE. Toxicity, Acetaminophen. eMedicine by WebMD [serial online]. Sep 2009;Accessed August 18, 2011. Available at http://emedicine.medscape.com/article/820200-overview.

  13. Heard KJ. Acetylcysteine for acetaminophen poisoning. N Engl J Med. Jul 17 2008;359(3):285-92. [Medline].

  14. James LP, Capparelli EV, Simpson PM, et al. Acetaminophen-associated hepatic injury: evaluation of acetaminophen protein adducts in children and adolescents with acetaminophen overdose. Clin Pharmacol Ther. Dec 2008;84(6):684-90. [Medline].

  15. Larson AM, Polson J, Fontana RJ, Davern TJ, Lalani E, Hynan LS, et al. Acetaminophen-induced acute liver failure: results of a United States multicenter, prospective study. Hepatology. Dec 2005;42(6):1364-72. [Medline].

  16. Marzullo L. An update of N-acetylcysteine treatment for acute acetaminophen toxicity in children. Curr Opin Pediatr. Apr 2005;17(2):239-45. [Medline].

  17. Micheal J Burns, Scott L Friedman, Anne M Larson. Acetaminophen (paracetamol) poisoning in adults: Pathophysiology, presentation, and diagnosis. UpToDate. Available at http://www.utdol.com/online/content/topic.do?topicKey=ad_tox/9576. Accessed February 24, 2010.

  18. Miller MA, Navarro M, Bird SB, Donovan JL. Antiemetic use in acetaminophen poisoning: how does the route of N-acetylcysteine administration affect utilization?. J Med Toxicol. Dec 2007;3(4):152-6. [Medline].

  19. Rivera-Penera T, Gugig R, Davis J, et al. Outcome of acetaminophen overdose in pediatric patients and factors contributing to hepatotoxicity. J Pediatr. Feb 1997;130(2):300-4. [Medline].

  20. Smith SW, Howland MA, Hoffman RS, Nelson LS. Acetaminophen overdose with altered acetaminophen pharmacokinetics and hepatotoxicity associated with premature cessation of intravenous N-acetylcysteine therapy. Ann Pharmacother. Sep 2008;42(9):1333-9. [Medline].

 
Previous
Next
 
Acetaminophen metabolism.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.