Acetaminophen Overdose

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Acetaminophen-Overdose

Definition

  • Acetaminophen poisoning is an overdose of the over-the-counter (OTC) pain medication, acetaminophen (eg, Tylenol, Biogesic), which is usually safe when used as recommended.
  • The maximum daily dose of acetaminophen is four (4) grams, but patients with chronic diseases (especially liver disease) may need to limit themselves to three (3) grams a day.
  • Acetaminophen poisoning may occur as a result of one large dose or chronic overdoses.

Causes

An overdose of acetaminophen can result from:

  • Intentional overdose (eg, suicide attempt)
  • Accidental overdose (eg, unsupervised children, altered judgment regarding appropriate acetaminophen intake)
  • Combining medications that contain acetaminophen (Acetaminophen is found in more combination products than any other drug; examples include acetaminophen and codeine, as well as acetaminophen and aspirin.)
  • Toxic levels of acetaminophen may also occur in patients with liver failure who are taking recommended doses

Risk Factors

The following factors increase your chance of developing acetaminophen poisoning:

  • Age: 15-24 years or older than 40 years (People over 40 are more likely to have severe effects.)
  • Gender: female
  • Suicidal behavior

Symptoms

Symptoms include:

  • Nausea
  • Vomiting
  • Excessive sweating
  • Pale skin
  • Symptoms of liver failure:
    • Anorexia
    • Nausea
    • Vomiting
    • Malaise
    • Abdominal pain (especially in the upper right portion of the abdomen)
    • Pale skin
    • Excessive sweating
    • Jaundice
    • Confusion
    • Stupor

Diagnosis

  • Blood Tests—Blood tests are done to determine the level of acetaminophen in your blood and to determine liver function (eg, liver enzyme tests, coagulation tests).
  • Rumack-Matthew Nomogram—This is an assessment to determine the effect on the liver. The test measures blood levels of acetaminophen relative to the time since ingestion of the medication.

Treatment

Monitoring

  • For children who have relatively low levels of acetaminophen in their blood, monitoring at home may be recommended.

Activated Charcoal

  • Activated charcoal can help prevent acetaminophen from absorbing in the gastrointestinal tract. It is taken by mouth.

N-acetylcysteine

  • In most cases of toxic acetaminophen overdose, N-acetylcysteine, an amino acid, will be given by mouth or IV (through the vein) as an antidote.
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Matt Vera is a registered nurse with a bachelor of science in nursing since 2009 and is currently working as a full-time writer and editor for Nurseslabs. During his time as a student, he knows how frustrating it is to cram on difficult nursing topics and finding help online is near to impossible. His situation drove his passion for helping student nurses through the creation of content and lectures that is easy to digest. Knowing how valuable nurses are in delivering quality healthcare but limited in number, he wants to educate and inspire students in nursing. As a nurse educator since 2010, his goal in Nurseslabs is to simplify the learning process, breakdown complicated topics, help motivate learners, and look for unique ways of assisting students in mastering core nursing concepts effectively.

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