Acetaminophen Overdose

Acetaminophen Overdose – General Information

Acetaminophen Overdose is also known as paracetamol overdose and Tylenol overdose and it is one of the common poisonings all over the world. Acetaminophen is a pain relieving and a fever reducing drug, but if it is taken in large doses it may be deadly. Acetaminophen may also be found in combination with other drugs such as:

• Tylenol Cold
• Darvocet
• Tylenol III
• Percocet

This drug is normally metabolized by the liver, but when patients intake more than the normal dose, the liver processing is not enough and the liver begins to use the second processing system. Unfortunately, this second system turns the drug in a toxic substance that in time damages the liver.
Here is a list of the most common causes of the Acetaminophen Overdose:

• Taking more acetaminophen than you are prescribed, or that is written in the prospect.
• Taking acetaminophen from more than one direction without noticing it
• If persons who have liver disease or are alcohol addicts take acetaminophen
• It is also used in the cases of suicide attempts.

The mortality rate in the case of Acetaminophen Overdose increases after two days from the intake, reaches the maximum in the forth day and then it starts to decrease. Academia is the single indicator of mortality and of the need of transplantation. Patients who have a poor prognosis are the followings:

• Patients who are suffering from renal insufficiency of grade III.
• Patients who suffer from hepatic encephalopathy.
• Patients who have a rise in prothrombin levels.
• Patients who take small doses for a prolonged period of time.

Acetaminophen Overdose – Symptoms

It is well known that any medical disorder (including Acetaminophen Overdose) can trigger a variety of symptoms. Therefore, some of this medical condition's most uncommon symptoms have not been listed here. This is why we strongly recommend you to contact your personal health care provider whenever you develop any unusual, bothersome or unpleasant symptoms. Your personal physician will be able to tell you if you are suffering from Acetaminophen Overdose or from any other medical disorder.
Here is a list of the most common symptoms of Acetaminophen Overdose:

• Abdominal pain
• Appetite loss
• Coma
• Convulsions
• Diarrhea
• Irritability
• Nausea
• Vomiting
• Sweating
• Upset stomach
• Diaphoresis
• Hypoglycemia
• Renal failure
• Cerebral edema
• Sepsis
• Multiple organ failure
• Gastrointestinal irritability
• Anorexia
• Central nervous system depression – this is not found in all of the cases, but only in those with a massive overdose.
• Hepatomegaly
• Drowsiness
• Listlessness
• Hypersensitivity reactions are rare and may include: urticaria, skin eruptions, pruritus or anaphylaxis.
• Hallucinations
• Excitement
• Ataxia
• Incoordination
• Cardiovascular depression
• Weakness
• Bluish skin especially in the zone of the lips and fingernails
• Difficulty in breathing
• Breathing shallow
• Cold skin
• Clammy skin
• Confusion
• Dizziness
• Eyes with small pupils
• Liver failure
• Loss of consciousness
• Low blood pressure
• Seizures
• Spasms of the stomach and intestinal tract
• Tiredness
• Respiratory arrest

Acetaminophen Overdose – Treatment

In the cases where Acetaminophen Overdoses does not lead to complications, the first treatment is a gastrointestinal decontamination, in which the principal role is played by actylcysteine, as it is the antidote. The gastrointestinal decontamination should be done in the interval of two hours from the intake, as that is the time needed for the acetaminophen to be absorbed. Patients may be administrated activated carbon, or can have a gastric lavage if the doctor considers that the quantity taken is life threatening. The gastric lavage can be done only in an hour from the ingestion, otherwise it has no effect. The activated carbon is useful because it absorbs the acetaminophen and reduces the gastrointestinal absorption.

When a patient takes an Acetaminophen Overdose he should be administrated within maximum an hour a dose of activated charcoal in order for the gastric decontamination to be done. The risk of hepatoxicity can be diminished if the patient who had an overdose of acetaminophen is treated in 10 hours from the intake. In the patients who had an Acetaminophen Overdose the levels of acetaminophen should be measured at every four hours, and if the levels are growing, then the treatment with acetylcysteine must be started at once, and if the concentration is lowering then it will be measured after four and even six hours. The treatment is the same in the children, pregnant women and elderly people as in adults, non-pregnant women and young people.
In the case that patients are suspected of having taken an Acetaminophen Overdose but they are asymptomatic, their personal healthcare provider or doctor will start the following treatment:

• If the patients come to hospital after a few minutes of taking the overdose the doctor will empty his stomach. This procedure is done by inducing vomiting and by placing a tube in the patient mouth, a tube that ends in the stomach.
• Acetylcysteine is the common used treatment in these cases, and for a better taste it may be mixed with orange juice.
• Activated charcoal is given in order to neutralize the drugs that may remain in the gastrointestinal tract.

In order to avoid a possible Acetaminophen Overdose patients should:

• Be well informed about the correct dose that they have to take and the quantity of acetaminophen from the preparations.
• Never mix medications that contain acetaminophen (such as paracetamol and codeine), but if their doctor recommends them to do so, they should follow his advice.
• Always ask their doctor about the how and when they should take the drug.
• Always inform the doctor, if he wants to prescribe them drugs, that they are under treatment with acetaminophen.
• Never take acetaminophen if they are accustomed to drink daily, before consulting a doctor.

Here is a list of drugs that can be prescribed and taken in the case of an overdose:

• Acetadote
• Acetylcysteine inhalation and acetylcysteine solution
• Mucomyst