Baby Talk: Curious Nikhil and the Crete hospital

To my untrained eye it looked like your regular flu. But my brother and his wife, both doctors, knew that these were symptoms of a Tylenol overdose.

sick baby illustration 8 (photo credit: )
sick baby illustration 8
(photo credit: )
The tension was crackling like static electricity on the ground floor of our rented villa in Crete. Though it was only the first morning after our mid-August arrival, with three families and three generations bunking together in a strange land, skirmishes were to be expected. However the tight, controlled, business-like tone used by my normally jovial doctor sister-in-law made me concerned. It seems that while my husband and I were trying to get our over-stimulated brood to sleep in our room the previous night, the noise I'd heard my mischievous four-year-old niece and two-year-old nephew making down the hall had been without any adult supervision. Their mother had left them asleep in their room with their tired father and gone to take a well-deserved shower after a long transatlantic flight. My parents, thinking everyone had hit the sack, went upstairs to zone out in front of the boob tube and unwind. Curious George and Georgette were on the loose. Since we were only staying one night in this three-bedroom villa before moving to our more permanent five-bedroom abode the next morning, no one was unpacking and suitcases were strewn everywhere - a perfect playground for these curious monkeys. And there was what to find: In compliance with new American security regulations, my mother had packed everything in her carry-on bag in clear Ziplocs. In one she'd put her mints for the plane and a pill bottle with a few various pain relievers, among other things. Upon packing up that Saturday morning, she noticed an empty mint container and saw that the pill bottle had been opened. After searching the room she found at least one gnawed-on Tylenol. She wasn't sure how many were there originally. My niece, Anjali, looked fine. But her younger brother, Nikhil, was vomiting, looking listless and totally uninterested in food. To my untrained eye it looked like your regular flu, minus the fever. But my surgeon brother and his internal medicine wife knew that these were extremely worrisome symptoms of a Tylenol overdose: Not having a fever makes perfect sense in the context of a possible overdose, since the medicine (also known by its Israeli trade name Acamol or the generic paracetamol or acetaminophen) is regularly taken to reduce fever. They briefly deliberated, checked medical journals on the Internet and whisked their children to the closest hospital to be tested and treated. As a simple, bumbling mother, I would probably have waited to see if things got worse. As a simple, bumbling mother, had my child truly overdosed on Tylenol, he could suffer from irreparable liver damage - or die. TYLENOL OVERDOSE is one of the leading causes of liver transplants in children in Israel and the main factor in making poisoning the sixth cause of death in children under 14. As it is the most widely used pain and fever medication in the world, it is found in most households. According to Dr. Michal Hemmo Lotem, the CEO of BETEREM National Center for Children's Safety and Health, it is the most common form of poisoning in children here. Hemmo says there are two ways children overdose on paracetamol: either through unintentional parental over-medication (i.e. when a child has vomited or made diarrhea soon after a dosage, leading parents to believe not enough medicine was absorbed and thus readministering) or through curious children somehow finding the medicine and taking it. If a curious child breaks into the medicine, parents are likely to see the trash and know what he has taken. But chillingly, if the parents are the cause of the overdose, it is most unlikely that they'd even know why the child is suffering, says Lotem. Symptoms may not appear for up to 24 hours, but damage could occur in even a few hours. Like with Nikhil, an overdose may present in symptoms such as nausea, vomiting, generally not feeling well, jaundice, poor appetite and stomach pain. Nothing too sinister or out of the ordinary, especially in the under five-year-old crowd that is most often affected. Again, I may have waited. "Parents need to go to a doctor if their child is struck with something suddenly and intensively," says Lotem. "Besides, with vomiting there is always chance of dehydration." I press her again to find out how I could know if my child had accidentally overdosed on Tylenol. She sighs and says she has no perfect answer. "What generally happens is parents come in and they don't know what's happening. They know their child is not okay, but can't put it into words. We doctors need to listen to parents' intuition." NIKHIL WAS taken to the closest hospital, which was more than an hour away. There, since it was the weekend, his blood was taken, yet the results would only arrive back from the lab days later. Had he come in within minutes of potentially imbibing the medicine, his stomach would have been emptied and he'd have been given oral activated charcoal to absorb all remaining traces from his stomach. Since it was already 10 hours after the potential overdose the doctors eventually decided to treat him with the "Tylenol antidote," N-acetylcysteine (NAC). NAC is considered most effective in the first eight hours and can prevent liver failure. The antidote's success is based on the relationship between the amount of Tylenol taken, how soon the treatment was started and the patient's initial health status. It is considered non-toxic, so like in Nikhil's case, it is often prescribed even if there is only concern of an overdose. Nikhil was hooked up to an IV for over 24 hours. He and his mother spent greater part of three days in the rural hospital. Within that time he made a full recovery. And on Monday late-afternoon, when he was discharged, his test results showed little chance of an overdose. Says my brother, "It's hard to know. By the numbers he was fine; we cannot prove he had an exposure. It could have been a false alarm." But according to Lotem, a false alarm is much preferable to the alternative, stating, "Medicine should be locked up in a house, just like a gun." BETEREM's recomendations * Medicine, including vitamins, should be stored far from a child's reach, either in a high cabinet or one that is locked * Buy bottles with childproof caps * Purchase special childproof pill storage boxes * Store medicines in their original packages. Do not store in food or drink containers * Discard expired medicines * Read labels carefully * Fully separate between medicine and food storage areas * Close medicine containers immediately after use * Do not take medicines in front of children * Don't try to convince children to take medicine by putting it in sweets * Keep all purses and personal bags away from children * Do not let children play with medicine containers, even if empty * Keep first-aid kits away from children * Phone the Poison Control Center's 24-hour hot line with any questions or concerns: (04) 854-1900 The writer is the mother of two-year-old twins and a big boy approaching four. [email protected]