Medicinal mishap: Intravenous paracetamol: cause for caution

A two-week-old 2.9 kg baby presented to a general hospital emergency department with acute bowel obstruction and underwent urgent laparotomy. Postoperatively the baby was given three doses of 290 mg intravenous paracetamol (instead of the prescribed 29 mg dose) over a 38-hour period. The error was detected 1-2 hours after the third dose, which was initially thought to be a single overdose. The preceding two overdoses were discovered six hours later and N-acetylcysteine was given, following the advice of a Poisons Information Centre toxicologist. The baby remained clinically stable and liver transaminases were normal throughout.