Médecine néonatale et pédiatrique

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Lethal Acetaminophen Poisoning Related to Error Prescription: Medico Legal Implications - About a Case Report

Mesrati Med Amine

Acetaminophen poisoning, leading to death, is a serious and dramatic accident for even the family and pediatricians. Prescribing error can engage the physician's responsibility. In this context, we report a case of lethal acetaminophen poisoning related to error prescription, occurred in an infant with underlying liver disease and we discuss its medico-legal implications. He was an 11 month-old boy, without medical history, who was presented to his pediatrician for a nasopharyngitis with gastroenteritis of three days duration. The prescription involved two drug forms of Acetaminophen. The total prescribed dose was 270 mg/kg/day. The death occurred after two days. A blood analysis tested before his death showed a major hepatic cytolysis with toxic level of acetaminophen. Forensic autopsy has been ordered. At dissection, the liver was palish and hemorrhagic. Toxicological screening showed a high level of acetaminophen (79 mg/l). Histological examination concluded to diffuse microvacuolar steatosis. This case report highlights the risk of hepatotoxicity of acetaminophen. This complication is even more serious if the child already has a congenital, unknown liver disease. The physician and the pharmacist's liability, in this case, would be incurred even with partial causal link.