Glutathione, glutathione-dependent enzymes and antioxidant status in erythrocytes from children treated with high-dose paracetamol


  • This study was presented at the 2001 Pediatric Academic Societies Meeting, Baltimore 28/4–1/52001. An abstract is presented in Pediatr Res 2001; 49: 453A.

Matitiahu Berkovitch MD, Clinical Pharmacology and Toxicology Unit, Assaf Harofeh Medical Centre, Zerifin 70300, Israel. Tel.: + 972 8 977 9152; Fax: + 972 8 977 9138; E-mail:


Aim To investigate glutathione and antioxidant status changes in erythrocytes from febrile children receiving repeated supratherapeutic paracetamol doses.

Methods Fifty-one children aged 2 months to 10 years participated in the study. Three groups were studied: group 1 (n = 24) included afebrile children who did not receive paracetamol; and groups 2 (n = 13) and 3 (n = 14) included children who had fever above 38.5°C for more than 72 h. Patients in group 2 received paracetamol at a dose of 50 ± 15 (30–75) mg kg−1 day−1 and those in group 3 received paracetamol above the recommended therapeutic dose, ie 107 ± 28 (80–180) mg kg−1 day−1. A blood sample was taken for the measurement of liver transaminases, gammaglutamil transferase (GGT), reduced glutathione (GSH), glutathione reductase (GR), glutathione peroxidase (GPX), glutathione S-transferase (GST), superoxide dismutase (SOD) and antioxidant status.

Results Aspartate aminotransferase activity in group 3 was higher than in the other groups (P = 0.027). GSH, SOD and antioxidant status were significantly lower in group 3 compared with groups 1 and 2 (mean differences: for GSH 3.41 µmol gHb−1, 95% confidence interval (CI) 2.10–4.72, and 2.15 µmol gHb−1, 95% CI 0.65–3.65, respectively; for SOD 856 U min−1 gHb−1, 95% CI 397–1316, and 556 U min−1 gHb−1, 95% CI 30–1082, respectively; and for antioxidant status 0.83 mmol l−1 plasma, 95% CI 0.30–1.36, and 0.63 mmol l−1 plasma, 95% CI 0.02–1.24, respectively). GR activity was significantly lower in groups 3 and 2 in comparison with group 1 (mean differences 3.44 U min−1 gHb−1, 95% CI 0.63–6.25, and 5.64 U min−1 gHb−1, 95% CI 2.90–8.38, respectively). Using multiple regression analysis, paracetamol dose was found to be the only independent variable affecting GR, GST and SOD activities (P = 0.007, 0.003 and 0.008, respectively).

Conclusions In febrile children, treatment with repeated supratherapeutic doses of paracetamol is associated with reduced antioxidant status and erythrocyte glutathione concentrations. These significant changes may indicate an increased risk for hepatotoxicity and liver damage.