Parents, lock up your Tylenol
It started out like any other Sunday morning on call, until I received a call from the emergency room physician.
"We have a toddler down here who somehow got a hold of his mother's Tylenol bottle. Not quite sure how many he managed to ingest but he's really not looking good. Could you come have a look at him?"
I raced to the trauma room at the Saint-Georges Hospital, in the Chaudière-Appalaches region, to find the physician assessing her patient, two nurses inserting an IV, as well as two very stunned and frightened parents, vigilantly standing watch over their little tyke.
Sick toddlers are reassuring only when they are wailing and refusing to be examined. This one was doing neither — he kept looking around but did not appear to be able to focus on anything or anyone, not even his mother. In between confused moans, he seemed far away, in a nightmare.
After completing my initial assessment and management, I took the parents aside to get a history. The mother's words were eerily familiar. In the week prior, I had seen two similar cases while working in rural Alberta.
The three stories all had a common thread: "While my child was playing, I left the room for no more than a few minutes, only to return to find him with an open bottle of Tylenol in his hands. He was eating the tablets like candy."
That is all it takes. Minutes. Enough time for a bathroom break, checking the stove or taking a call.
Toddlers, being curious, will find a way to get into anything and everything. Cupboards and drawers are indiscriminately opened and if there is nothing interesting in them, they become the steps of a ladder.
Bowls, jars, and containers are emptied and plundered. Imagine their glee when they easily open the elusive "red candy bottle" — the maracas their parents are constantly rattling. Toxic treats come out and they feast!
His condition took a turn. His mother looked at me and posed the dreaded question: "Doctor, is he going to make it?"
At that point, nothing was clear. My patient has been in the trauma room for no more than 20 minutes and Tylenol levels can only be requested four hours after ingestion.
The mother was right to be worried. Tylenol is one of the leading causes of overdose in children in North America. If left untreated, it can lead to liver failure requiring transplant.
I told her, "We don't have enough information to properly answer your question yet, but we'll do everything in our power to make him better."
As we waited for more results, we continued close observation and started our antidote, N-acetylcysteine, also known as NAC.
Night fell, and as our patient slumbered, labs were drawn and calls were exchanged between nursing, poison control and myself. This intricate teamwork ensures that all our pediatric patients receive the best possible care. The night nurse found him more alert and responsive. By morning, he was back to being a mischievous little imp. The antidote infusion was complete and the relieved family was ready to go home.
Parents, I implore you, awareness is key. Simple precautions can ensure that these preventable incidents do not occur.
Prior to discharge, I met with the mother and reviewed with her the following recommendations:
Should this kind of unfortunate event occur despite these precautions and you find your child ingesting medication, follow these guidelines:
For more information, please see the links below: