Acetaminophen Overdose

Also Known As
* Tylenol overdose and Paracetamol overdose

Description
* Acetaminophen is one of the most commonly used over-the-counter pain relievers
and fever-reducers. It is also found in combination with many over-the-
counter and prescription medications, such as Tylenol Cold, Darvocet, Tylenol
#3, and Percocet. Acetaminophen is metabolized (processed) by the liver. When
too much acetaminophen is taken, the normal liver-processing system becomes
overwhelmed, and the liver uses a second processing system. This second
processing system, unfortunately, turns the acetaminophen into a very toxic
substance that severely damages the liver.

Symptoms
* Initially often only nausea/vomiting/sweating, then no other symptoms for 24 hours.
* At 24-48 hours, liver damage occurs, which can lead to right upper quadrant
abdominal pain, jaundice (yellow skin) or icterus (yellow eyes), confusion,
coma, kidney failure, and death.

Cause
* Taking more acetaminophen than directions call for on the bottle
* Taking acetaminophen from more than one source without realizing it
* Use of acetaminophen by those who use alcohol or who have liver disease
* Suicide attempts

How The Diagnosis Is Made
* History of acetaminophen overdose
* Examination may show jaundice (yellow skin) or icterus (yellow eyes),
confusion, or coma.
* Blood Tests:

1. Acetaminophen level is elevated
2. Liver test abnormally high-elevated AST, ALT, bilirubin
3. Kidney tests may be high-elevated BUN, creatinine
4. Tests may be done to rule out the presence of other drugs.

Risk Factors
* Patients with a history of alcohol abuse, liver disease, children above age 6,
the elderly, or those who take medications for seizures can develop
acetaminophen toxicity at doses near or just above those recommended.

Treatment
* The stomach should be emptied by forced emesis using ipecac syrup (induces
vomiting) or gastric lavage (tube placed in stomach and material in stomach
flushed, then suctioned out). Both of these measures need to done within 2
hours of the acetaminophen overdose. Induction of vomiting at home should
only be done as directed by a physician or Poison Control.
* After 2 hours, activated charcoal is given, binding to acetaminophen to
prevent its further absorption.
* In the hospital, if the physician determines that the blood level of
acetaminophen is toxic, N-acetylcysteine (Mucormyst) is given.
N-acetylcysteine is an antidote for the toxins produced by acetaminophen, and
may be effective up to 36 hours or more after Tylenol overdose.

If You suspect This Condition
* Even without any symptoms, you need to seek immediate attention by contacting
Poison Control, calling 911, or going to a hospital. Many individuals have
few symptoms early on. Consequently, by the time symptoms develop, severe
liver damage may occur, and even death.

Similiar Conditions
* Hepatic encephalopathy