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Acetaminophen Overdose

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Tylenol overdose and Paracetamol overdose


  • 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.

  • 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.

  • 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

  • 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.

  • 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.

  • 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.

  • 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.

  • Hepatic encephalopathy





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