Paracetamol poisoning

Administration of paracetamol (acetaminophen) has analgetic and antipyretic effect. After trauma paracetamol has an anti-inflammatory activity. It was presumed that paracetamol in therapeutic doses had fewer and more acceptable side-effects than other analgetic drugs such as acetylsalicylic acid and NSAID-drugs. However, in toxic concentrations, paracetamol is more life-threatening. The toxic effects of paracetamol most often occur in the liver and kidneys. Phosphate and lactate turn-over can also be impaired. Paracetamol poisoning can induce temporary liver disfunction or even irreversible liver failure with liver transplantation as the only therapeutic possibility. Chronic alcoholics are especially at risk, as liver damage may occur following paracetamol even in recommended doses. When intoxication with paracetamol is presumed, administration of N-acetylcysteine is vital. N-acetylcysteine therapy should be initiated not later than 15 hours after paracetamol intake. Moreover, the antitoxic effect has been observed even when N-acetylcysteine therapy is initiated 24-36 hours after presumed paracetamol intake. Measures of preventing further absorption of paracetamol from the gastrointestinal tract should be taken. Activated charcoal should be given if less than two hours have passed since paracetamol intake. Between two and four hours following paracetamol intake gastric lavage should be performed. During the last 10 years the incidence of paracetamol self-poisoning has increased, but death following paracetamol poisoning is relatively constant at around nine per year in Denmark. It is suggested that the incidence of serious cases of paracetamol poisoning could be reduced by simple measures. Special attention should be paid to the risk-group of chronic alcoholics.     

Paracetamol poisoning in the north east of England: presentation, early management and outcome

1. Paracetamol is increasingly involved in self-poisoning in the United Kingdom and remains a common cause of fatal poisoning. 2. To document the epidemiology and early management of paracetamol poisoning data were collected on consecutive patients with suspected paracetamol poisoning presenting to 6 hospitals in the North East of England over 12 weeks in 1994. 3. There were 400 presentations (attendance rate 1.14/10(3) population/yr) involving 343 persons (45% male). Paracetamol concentrations at 4 h correlated weakly with reported paracetamol dose (R = 0.49, P < 0.0001) and were similar comparing those treated and not treated by gastric decontamination. 4. In 38 (9%) cases paracetamol concentrations were above the appropriate nomogram treatment line, including 3% and 20% of patients who reported ingesting less than and more than 12 g respectively. In 21 patients acetylcysteine treatment was deferred until admission to the ward, the mean delay involved was 2.8 h. 5. One patient died, from arrhythmias caused by co-ingested dothiepin. 6. Paracetamol poisoning is common. Most cases do not have potentially toxic plasma paracetamol concentrations, but those who do often present late and antidotal treatment may be delayed inappropriately.     

Glomus tympanicum in infancy

A glomus tympanicum tumor, limited to the cochlear promontory, was excised from the middle ear of a 6-month-old girl. To our knowledge, there have been no reports of temporal bone paragangliomas occurring at a younger age. Diagnosis, therapy, and the special characteristics of pediatric glomus tumors are discussed.     

Scimitar syndrome in infancy

OBJECTIVES: The objectives of this study were to determine the anatomic and physiological factors most responsible for the severe symptoms and poor prognosis of infants with scimitar syndrome. BACKGROUND: Whereas the diagnosis of scimitar syndrome is often made incidentally in older children and adults who undergo chest radiography for diverse reasons, infants in whom the diagnosis is made typically present with severe symptoms and have a poor prognosis. METHODS: The clinical, catheterization and imaging data of 13 consecutive infants with scimitar syndrome who underwent cardiac catheterization in the 1st 6 months of life were reviewed, with emphasis on the pulmonary artery pressure, pulmonary and cardiovascular anatomy, therapeutic interventions and outcome. RESULTS: Twelve of the 13 infants had pulmonary hypertension at the time of diagnosis. Six patients died despite specific treatment. Eleven of 13 infants had associated cardiac malformations and 9 had large systemic arterial collateral channels to the right lung. Seven patients had anomalies involving the left side of the heart, especially varying degrees of hypoplasia of the left heart or aorta, and six of these patients died. Ten patients underwent surgical or transcatheter therapy in the 1st year of life. Systemic arteries to the right lung were ligated in three patients and occluded by transcatheter embolization in four. Balloon angioplasty was carried out in two patients, one with stenosis of the left-sided pulmonary veins and one with stenosis of the anomalous right pulmonary vein. The latter had placement of a balloon-expandable stent. In both patients, pulmonary vein stenosis progressed. Six patients had surgical repair of associated cardiovascular anomalies, and two required repair of extracardiac congenital anomalies. Occlusion of the anomalous systemic arteries was generally associated with clinical improvement, but congestive heart failure and pulmonary hypertension recurred in those patients with associated cardiovascular anomalies, whose condition subsequently responded after correction of the shunt lesions. CONCLUSIONS: The severe symptoms and pulmonary hypertension found in infants with scimitar syndrome have many causes. Anomalous systemic arterial supply, pulmonary vein stenosis and associated cardiovascular anomalies play a significant role, and the ultimate outcome of individual infants depends on the feasibility of treating these anomalies in early infancy.     

Heat stroke in infancy

We observed a 16-month-old infant with residual brain damage following a heat stroke from being left in a parked automobile. In contrast with adults, in whom heat stroke usually follows strenuous exercise, the condition in infants usually results from excessive environmental temperature and/or dehydration. Early recognition of the illness is imperative. Three cardinal freatures are hot, dry skin, central nervous system disturbance, and hyperpyrexia. Immediate treatment should be aimed at improving circulation with volume expanders and rapid cooling. Other supportive measures may be necessary to control seizures, renal failure, hematologic abnormalities, or hepatic involvement.     

Topiramate efficacy in infancy

Syncytial giant cell hepatitis is a severe form of hepatitis characterized by diffuse giant cell transformation of hepatocytes. The disease may evolve to chronic cholestatic cirrhosis necessitating liver transplantation. We report the case of an adult liver transplant recipient presenting with early recurrent disease without concomitant clinicobiochemical syndrome. Early recurrence of giant cell hepatitis after liver transplantation favors the hypothesis of a transmissible agent as the etiology of the disease. Routine follow-up liver biopsy is necessary in these cases in order to gain more information about the precise incidence and aggressivity of disease recurrence in the allograft.     

Self-perception and action in infancy

By 2-3 months, infants engage in exploration of their own body as it moves and acts in the environment. They babble and touch their own body, attracted and actively involved in investigating the rich intermodal redundancies, temporal contingencies, and spatial congruence of self-perception. Recent research is presented, which investigates the spatial and temporal determinants of self-perception and action infancy. This research shows that, in the course of the first weeks of life, infants develop an ability to detect intermodal invariants and regularities in their sensorimotor experience, which specify themselves as separate entities agent in the environment. Recent observations on the detection of intermodal invariants regarding self-produced leg movements and auditory feedback of sucking by young infants are reported. These observations demonstrate that, early in development and long before mirror self-recognition, infants develop a perceptual ability to specify themselves. It is tentatively proposed that young infants' propensity to engage in self-perception and systematic exploration of the perceptual consequences of their own action plays an important role in the intermodal calibration of the body and is probably at the origin of an early sense of self: the ecological self.     

Maternal language in infancy.

Observations of 36 preterm infants and their English-speaking mothers suggest that maternal language to the infant varies as a function of the age and ordinal position of the infant and maternal education. The relationship between maternal language at 1 mo of age and the mother's verbal style to her older infant allows for early identification of maternal language input styles and, therefore, has important implications for mother–infant intervention programs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Studies in inductive inference in infancy

Imitation of events was used to explore the inductive generalizations that 14-month-olds have made about animals, vehicles, and household artifacts. In Experiment 1 infants generalized domain-specific properties such as drinking to animals but not to vehicles, whereas they generalized domain-neutral properties such as going into a building to exemplars from both domains. The next four experiments showed that infants tend to interpret animal events very broadly, for example, construing a dog merely as a land animal rather than as a differentiated kind in its own right. Infants were somewhat more selective in their construals of vehicles. Experiment 6 showed that 14-month-olds also generalize "basic-level properties" very broadly. For example, they chose a pan to demonstrate drinking almost as often as a cup and fed a bone to a bird as often as to a dog. By 20 months, their selections narrowed appropriately for artifacts, but were still overgeneralized for natural kinds. The experiments indicate that infants tend to generalize their early experiences broadly across domains, often across exemplars that have a variety of different surface characteristics. The data suggest that it is the conceptual meaning of objects, rather than their physical features, that controls early associative learning.     

Individual differences in emotionality in infancy

In this multimethod investigation of early emotionality, we observed 112 8- to 10-month-olds' responses to standard procedures consisting of multiple brief episodes that elicited joy, fear, anger, and discomfort to aversive stimulation. We obtained parental reports about the infants' temperament and observed their emotional tone during naturalistic interactions with their mothers. Parameters of emotional response to the standard procedures (latency, discrete behaviors, and average and peak intensity across facial, vocal, and bodily channels) cohered strongly within each episode. To a lesser extent and with the exception of anger, they also cohered across episodes targeting the same emotion. The four emotions appeared orthogonal, except for the peak intensity of response, which cohered modestly across the 3 negative emotions. The emotionality measures converged to some extent: responses to the standard procedures and father-reported temperament related meaningfully to the infant's emotional tone in mother-child interactions. As predicted, infants' capacity for focused or effortful attention was modestly associated with better modulated negative emotionality.