Clinical Characteristics, Outcomes, Disposition, and Acute Care of Children and Adolescents Treated for Acetaminophen Toxicity

Julia Shekunov, Charles P. Lewis, Jennifer L. Vande Voort, J. Michael Bostwick, Magdalena Romanowicz

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Objective: Acetaminophen is a common cause of intentional and inadvertent overdoses among children and adolescents worldwide. Little is known about characteristics and clinical outcomes of these youths. The primary goal of this naturalistic study was to describe the psychiatric characteristics, medical management, outcomes, and dispositions of children and adolescents evaluated for excessive acetaminophen exposure. Methods: The Rochester Epidemiology Project database was searched for all patients ages 0-18 treated for excessive acetaminophen exposure in Olmsted County, Minnesota, during a 7-year period (2004-2010). Demographic factors, overdose intentionality, medical and psychiatric treatment, mental health and addiction history, and disposition from the emergency department (ED) were documented. Results: Of 110 cases of acetaminophen overdose (89 female patients and 21 male patients), 97 (88%) were intentional and 13 (12%) were unintentional. Fifteen patients (14%) were discharged from the ED, and 69 (63%) required admission to a medical unit. Sixty-four (59%) received N-acetylcysteine. Ninety-eight (89%) were evaluated by psychiatry, and 80 (73%) were admitted for psychiatric hospitalization. Most had at least one psychiatric diagnosis, most commonly depression (55%); 22 (20%) had a prior suicide attempt. Substance use was common, notably alcohol dependence (N516, 15%), alcohol abuse (N518, 16%), and cannabis abuse (N518, 16%). All survived and recovered without liver transplant. Conclusions: Among pediatric patients with acetaminophen overdoses, psychiatric comorbidities and substance use were common. Most received both inpatient medical and psychiatric treatment. Interventions that restrict acetaminophen access are needed for this population, as are suicide risk reduction interventions for delivery in emergency settings.

Original languageEnglish (US)
Pages (from-to)758-765
Number of pages8
JournalPsychiatric Services
Issue number7
StatePublished - Jul 2021

Bibliographical note

Funding Information:
Dr. Lewis reports serving as a site investigator for multicenter trials funded by Neuronetics, Inc., and NeoSync, Inc. Dr. Vande Voort reports receipt of equipment in-kind support from Assurex Health, Inc., and service as a site investigator for a multicenter study funded by Neuro-netics, Inc. The other authors report no financial relationships with commercial interests.

Publisher Copyright:
© 2021 American Psychiatric Association. All rights reserved.


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