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Discover Pediatric Collections on COVID-19 and Racism and Its Effects on Pediatric Health

American Academy of Pediatrics
Special Article

Intravenous Acetaminophen in the United States: Iatrogenic Dosing Errors

Richard C. Dart and Barry H. Rumack
Pediatrics February 2012, 129 (2) 349-353; DOI: https://doi.org/10.1542/peds.2011-2345
Richard C. Dart
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Barry H. Rumack
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Abstract

An intravenous formulation of acetaminophen was introduced to the United States in 2011. Experience from Europe indicates that serious dosing errors are likely to occur. Most events have involved a 10-fold dosing error in small children caused by calculating the dosage in milligrams, but then administering the solution in milliliters. The solution is 10 mg/mL; therefore, a 10-fold overdose occurs. Evaluation of overdose with the intravenous formulation is similar to oral overdose. A serum acetaminophen concentration should be drawn 4 hours after the infusion was started or as soon thereafter as possible. If the serum acetaminophen concentration plots above the treatment line on the Rumack-Matthew nomogram, treatment with acetylcysteine should be initiated. Health care providers are encouraged to contact their regional poison center (1-800-222-1222) so that dosing errors will be reported, and the experience with this new product can be accumulated.

KEY WORDS
  • acetaminophen
  • paracetamol
  • adverse event
  • intravenous administration
  • human
  • Abbreviations:
    NAPQI —
    n-acetyl-p-benzoquinoneimine
    • Accepted October 24, 2011.
    • Copyright © 2012 by the American Academy of Pediatrics

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    Pediatrics
    Vol. 129, Issue 2
    1 Feb 2012
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    Intravenous Acetaminophen in the United States: Iatrogenic Dosing Errors
    Richard C. Dart, Barry H. Rumack
    Pediatrics Feb 2012, 129 (2) 349-353; DOI: 10.1542/peds.2011-2345

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    Intravenous Acetaminophen in the United States: Iatrogenic Dosing Errors
    Richard C. Dart, Barry H. Rumack
    Pediatrics Feb 2012, 129 (2) 349-353; DOI: 10.1542/peds.2011-2345
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    • Article
      • Abstract
      • Differences Between Oral and Intravenous Overdosage
      • Evaluation and Management of Intravenous Acetaminophen dosing Errors
      • Conclusions
      • ACKNOWLEDGMENT
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