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Acetaminophen Poisoning in Children

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  • Acetaminophen was involved in the most accidental poisonings among infants younger than 6 months
  • Unintentional ingestions, including exploratory exposures, made up the majority (50.7 percent) of calls to U.S. poison control centers among infants younger than 6 months
  • Nearly 37 percent of the calls were the result of therapeutic errors, including giving infants a different dosage of medication than was intended or giving a medication twice, too soon, or via the wrong route
  • N-acetyl cysteine (NAC) is an antidote for acetaminophen toxicity

Meds Killing Children - OTC Drug Kills, NAC Supplement Saves

January 27, 2016 | 36,309 views
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By Dr. Mercola

Commonly used over-the-counter medications can be deadly if they fall into the wrong hands, like those of children.

Pediatricians generally begin advising parents on poisoning prevention when their children reach about 6 months of age, the time when many infants become more mobile and begin to increasingly explore their environment.

A new study published in the journal Pediatrics suggests poison prevention education should begin even sooner. Researchers from Banner-University Medical Center Phoenix in Arizona reviewed calls to poison control centers across the U.S. related to infants younger than 6 months old.1

A surprisingly high number of calls were made — more than 270,000 in all, 97 percent of which were unintentional.

Acetaminophen (Tylenol) Accounts for Most Accidental Infant Poisonings

Unintentional ingestions, including exploratory exposures, made up the majority (50.7 percent) of the calls.

However, a sizeable portion (nearly 37 percent) of the calls were the result of therapeutic errors, including giving infants a different dosage of medication than was intended or giving a medication twice, too soon, via the wrong route or administering the wrong medication entirely.

Acetaminophen was the medication involved in the most accidental poisonings, accounting for 22,000 medication exposures and close to 5,000 general exposures.2 Acetaminophen is often recommended for infants instead of alternatives like ibuprofen.

In fact, acetaminophen is the most common pain reliever given to U.S. children, and it’s estimated that more than 11 percent of U.S. children take the drug during any given week.3 In adults, taking just a bit too much can have significant health risks, particularly for your liver.

Acetaminophen poisoning is responsible for nearly half of all acute liver failure cases in the U.S.4 Among adults, taking just 25 percent more than the daily recommended dose — the equivalent of just two extra strength pills per day — can cause liver damage after just a couple of weeks of daily use.5

When taken all at once, just under four times the maximum daily dose can be lethal to adults.

Previous research has also shown that taking just a little more than the recommended dose over the course of several days or weeks (referred to as "staggered overdosing") can be more risky than taking one large overdose.6

Children metabolize acetaminophen differently than adults, and the risks of liver failure from too much acetaminophen are thought to be lower among children than adults.7 However, liver injury has been reported among children given repeated doses.8

NAC Is an Antidote to Acetaminophen Overdose

N-acetyl cysteine (NAC) is an antidote for acetaminophen toxicity and is well worth knowing about if you ever use acetaminophen or keep it in your house. NAC is administered as part of standard care in cases of acetaminophen overdose.

While I generally do not recommend using acetaminophen-containing drugs for minor aches and pains, they are sometimes necessary to temporarily suppress severe pain, such as post-surgical pain. For those instances, I recommend taking it along with NAC.

It is believed the liver damage acetaminophen causes is largely due to the fact that it can deplete glutathione, an antioxidant compound secreted by your liver in response to toxic exposure.

Glutathione also helps protect your cells from free radical damage. If you keep your glutathione levels up, the damage from the acetaminophen may be largely preventable. NAC is the rate-limiting nutrient for the formation of the intracellular antioxidant glutathione, which is why it's such an effective antidote.

Mortality due to acetaminophen toxicity has been shown to be virtually eliminated when NAC is promptly administered in cases of acetaminophen overdose. So whether you are taking Tylenol in prescription or over-the-counter form, I strongly suggest taking NAC along with it.

And, if you have children and keep acetaminophen in your home, I strongly recommend keeping a bottle of NAC as well in case of accidental overdose. NAC therapy should be initiated within eight hours of an acute overdose for best results. If you suspect an overdose has occurred, seek medical help right away.

If this isn’t an option, the World Health Organization (WHO) recommends the following protocol:9

“Oral administration is the preferred route for NAC therapy unless contraindications exist (e.g aspiration, persistent vomiting). The usual recommended loading dose is 140 mg/kg followed in 4 hours by a maintenance dose of 70 mg/kg orally given every 4 hours.

This dosing is commonly recommended to be continued for 72 hours; however more recent clinical experience supports tailoring the duration of therapy to the patient’s clinical condition.”

Other Dangers Include Cough/Cold Meds, Ibuprofen, Diaper Rash Creams

The featured Pediatrics study noted other medication risks to infants aside from acetaminophen. Poison center calls were also made due to ingestion of:

H2 blockers (for acid reflux) Gastrointestinal medications Combination cough/cold products
Antibiotics Ibuprofen (Motrin, Advil, etc.) Diaper creams
Plants Creams and lotion Makeup

Researchers were surprised to find ibuprofen on the list of calls related to infants six months and younger, since this medication isn’t recommended for this age group.

Cough and cold medications are also not recommended for children under the age of 6, and the U.S. Food and Drug Administration even warns that for infants and children younger than 2, these medicines may have serious and potentially life-threatening side effects.10

Unfortunately, unintentional poisoning due to medications occur all too often among children. The U.S. Poison Control Center receives nearly 500,000 calls per year related to young children accidently getting into medicine. This works out to one call every minute of every day.

In 2012, 64,000 kids were treated in emergency rooms for medicine poisoning; that’s one child every eight minutes, according to a report from Safe Kids.11

Most Child Medication Poisonings Occur From Parents’ or Grandparents’ Drugs

In 3 out of 4 cases of child drug poisonings, the medication belonged to a parent (39 percent of cases) or grandparent (38 percent of cases). The fact that grandparents’ medication represents this much of a poisoning threat is due to the changing nature of typical households in the U.S.

There’s been a 23 percent increase in the number of grandparents living with their grandchildren since 2005, and 1 in 8 grandparents provide regular care for their grandchildren.

Considering that older adults are among the most heavily medicated populations, with the average adult aged 65 and older taking 28 prescription per year,12 this factor alone significantly increases children’s risk of accidental drug poisoning. While both parents and grandparents acknowledged that the safest place to keep medications is “up and away” from children, many were making exceptions that would put kids at risk.

When asked what grandparents worried over in terms of keeping kids safe, more identified electrical outlets than medications. Yet, 36 times more children visit emergency rooms due to medication poisoning than electrocution.13

The fact is medication usage is so common that many become complacent, neglecting to regard their pills as potential killers. Adding to the problem, many seniors take medications multiple times a day and purposely keep them in easy-to-access, prominent locations so they don’t forget a dose.

These 7 Common Medications Can Be Deadly to Kids

In many cases, just one pill — or less — can cause permanent or life-threatening damage in a small child. The following seven medications are examples; if you have any of these in your home, please keep them safely out of the reach of children living in or visiting your home:

Heart Pills — In children, they can cause dangerously low blood pressure and heart rate, and even lead to shock. Muscle Rubs — Camphor is especially dangerous because ingesting it works so quickly.

Symptoms occur within 10 to 20 minutes, and often children can go into seizures without any warning.
Prescription Pain Medications — For an infant, even half a tablet of hydrocodone can be lethal.
Aspirin and Oil of Wintergreen — Oil of wintergreen is particularly hazardous because its pleasant smell tempts toddlers to ingest it.

But one teaspoon of oil of wintergreen is the equivalent of nearly 90 baby aspirins.

This is a life-threatening dose for a toddler or child.
Antidepressants — After pain medications, antidepressants are the second-highest cause of accidental death from poisoning in children younger than 6. Blood Pressure Patches, Eye Drops, and Nasal Sprays — These medications are designed to be absorbed over time through your skin.

They can lead to serious consequences when ingested by a toddler. As little as 6 ml can lead to a coma.
Diabetes Drugs — As these medications are more commonly prescribed, the incidence of pediatric poisonings has also increased.

If you see your child ingest a pill or medication of any kind, don’t wait to take action. Your child may appear fine at first, but deadly side effects can appear hours later when it’s too late.

If you’re in the U.S. call 911 or the National Poison Control Center at 1-800-222-1222 if you even suspect your child has eaten an adult (or unknown) medication. If you’re in another country, contact emergency help immediately. Likewise, if your child is displaying any of the poisoning symptoms below, you should call for help immediately.

Seizures Low blood pressure or heart rate Delirium
Unusual sleepiness Lethargy Nausea or vomiting
Agitation Coma

5 Tips for Preventing Medication Poisoning

Any time you give medication to a child, carefully consider the risks versus the benefits, and be sure to carefully follow dosage instructions. Do not give more than the recommended dose, double-up on doses or use for longer than is recommended.

Often, preventing medication poisoning in children is as simple as keeping these drugs safely out of children’s reach at all times. Safe Kids recommends the following common sense precautions:

  1. Keep all medicine (including children’s medicine) up and away when young children are around, even medicine you take every day.
  2. Be alert to potential hazards of medicine stored in other locations, like pills in purses, vitamins on counters, and medicine on nightstands.
  3. Even if you are tempted to keep it handy in between doses, put medicine out of reach after every use.
  4. Choose child-resistant caps for medicine bottles, if you're able to. If pill boxes or non-child resistant caps are the only option, it's even more important to store these containers up high and out of sight when caring for kids.
  5. If you live in the U.S., program the U.S. Poison Help Number (1-800-222-1222) into your phones.

Top Natural Tylenol Alternatives

Tylenol and related products are familiar household items for many, but as mentioned they are a top source of poisonings among children and adults. Further, they are not the only option when you need relief from pain. For instance, the Emotional Freedom Techniques (EFT) works very effectively for relieving pain and can be used for children as well.

The Advanced Muscle Integration Technique (AMIT) helps treat muscle injuries and pain as well, while these simple exercises may work wonders for treating back pain. No matter what your reason for taking Tylenol, type it into the search box above and you’ll likely find a natural alternative.

And if chronic pain is your problem, the following options provide excellent pain relief without any of the health hazards that acetaminophen and other pain relievers carry.

  • Astaxanthin: One of the most effective oil-soluble antioxidants known. It has very potent anti-inflammatory properties and in many cases works far more effectively than many NSAIDs. Higher doses are typically required and one may need 8 mg or more per day to achieve this benefit.
  • Ginger: This herb is anti-inflammatory and offers pain relief and stomach-settling properties. Fresh ginger works well steeped in boiling water as a tea or grated into vegetable juice.
  • Curcumin: Curcumin is the primary therapeutic compound identified in the spice turmeric. In a study of osteoarthritis patients, those who added 200 mg of curcumin a day to their treatment plan had reduced pain and increased mobility.14 In fact, curcumin has been shown to have potent anti-inflammatory activity, as well as demonstrating the ability in four studies to reduce Tylenol-associated adverse health effects.15
  • Boswellia: Also known as boswellin or "Indian frankincense," this herb contains powerful anti-inflammatory properties, which have been prized for thousands of years. This is one of my personal favorites as I have seen it work well with many rheumatoid arthritis patients.
  • Bromelain: This protein-digesting enzyme, found in pineapples, is a natural anti-inflammatory. It can be taken in supplement form, but eating fresh pineapple may also be helpful.
  • Cetyl Myristoleate (CMO): This oil, found in fish and dairy butter, acts as a "joint lubricant" and an anti-inflammatory. I have used this for myself to relieve ganglion cysts and a mild annoying carpal tunnel syndrome that pops up when I type too much on non-ergonomic keyboards. I used a topical preparation for this.
  • Evening Primrose, Black Currant and Borage Oils: These contain the fatty acid gamma linolenic acid (GLA), which is useful for treating arthritic pain.
  • Cayenne Cream: Also called capsaicin cream, this spice comes from dried hot peppers. It alleviates pain by depleting the body's supply of substance P, a chemical component of nerve cells that transmits pain signals to your brain.
  • Therapeutic modalities such as yoga, acupuncture, meditation, hot and cold packs, and even holding hands can also result in astonishing pain relief without any drugs.

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