Proposta de protocolo para intoxicação por acetaminofeno em pediatria

Abstract

Background: Exogenous poisonings represent a relevant public health problem, particularly in the pediatric population, occurring predominantly as accidental events, with medications as the main agent involved. Paracetamol stands out due to its widespread use and extensive availability in households. Overdose of this drug is a major cause of drug-induced acute liver failure and is associated with severe and potentially preventable outcomes, including death. Objective: To conduct a literature review to develop a clinical protocol for the management of acetaminophen poisoning in pediatrics, based on scientific evidence, aiming to facilitate and standardize care, thereby reducing complications and improving clinical outcomes. Methods: A literature review was conducted, and a clinical protocol proposal was developed after analysis of the selected material. The search was performed in the PubMed and BVS databases. Recent studies and relevant technical documents published in English and Portuguese were included. The selected material was fully analyzed to provide the scientific basis for the proposed protocol. Results: The literature demonstrates that N-acetylcysteine is the cornerstone of treatment for acetaminophen poisoning, with time-dependent efficacy. Early initiation, preferably within the first 8 hours after ingestion, is the main factor associated with the prevention of hepatotoxicity and the reduction of severe outcomes, such as acute liver failure and the need for liver transplantation. Management should be based on assessment of the ingested dose, time since exposure, and serum acetaminophen concentration interpreted using the Rumack–Matthew nomogram, with continuous clinical and laboratory monitoring. Conclusion: Despite broad agreement in the literature regarding management recommendations, most available evidence is of low quality, highlighting the need for standardized protocols and more robust pediatric studies. In addition to appropriate management, preventive strategies—particularly health education and caregiver guidance on the safe use and storage of medications—are essential to reduce the occurrence of poisonings in childhood.