Background: Acetaminophen (paracetamol) is widely used in children as an antipyretic because its safety and efficacy are well established. Parental anxiety coupled with easy availability makes it one of the common poisonings seen in children. The symptoms of acetaminophen intoxication are non specific. The availability of acetaminophen in various concentrations and preparations, delays the diagnosis and treatment of acetaminophen intoxication in unintentional toxicity. Objective: To analyse the toxic effects of acute and multiple dose acetaminophen ingestion in a tertiary care pediatric emergency setting. Methods: Case records of 54 children diagnosed with acetaminophen toxicity between February 2009 and February 2013 were retrospectively analysed. Result: Acetaminophen toxicity was common in infants, common diagnosis at presentation being viral fever with vomiting . Hepatomegaly and elevated liver enzymes were noted in the majority. Double strength preparation (250mg/5ml) in accidental and drops (100 to 125mg /ml) contributed to toxicity in multi dose ingestions. Parenteral N Acetyl cysteine was well tolerated. Conclusion: Unintentional acetaminophen toxicity is as common as accidental ingestion. High index of suspicion is important. It mimics common childhood illness. Detailed prescription of acetaminophen and parental counseling are necessary. 

Keywords: Acetaminophen; NAC; N-acetylcysteine; Paracetamol; Poisoning; Toxicity.