Acetaminophen Toxicity

Acetaminophen overdose means taking

more than it is safe to take. It may also be
called acetaminophen poisoning.
Acetaminophen is called paracetamol in
countries outside the United States. When
used correctly, acetaminophen is a safe
drug that decreases pain and fever. Many
medicines contain acetaminophen,
including some that you can buy without a
prescription.
What causes an acetaminophen overdose?
The most acetaminophen that is safe for most people to take
is 4,000 milligrams (4 grams) in a 24-hour period. An
overdose means you have taken more than is safe in a 24-
hour period. The following are ways an unplanned overdose
may happen:
You take more than the recommended dose. You might
accidentally take too much if your pain or fever did not go
away after the recommended dose. You may also get too
much if you take acetaminophen for too many days in a row.
 You accidentally take more than one medicine at a time. Many
medicines contain acetaminophen along with other drugs. These
include medicines for colds, the flu, allergies, or trouble sleeping. You
may have taken more than one medicine that contains
acetaminophen, and the total was too much.
You take an extended-release form. When you take extended-release
pills, the medicine stays in your body longer. You are supposed to take
these medicines less often than you would take regular
acetaminophen. If you take this medicine too often, you will have too
much in your body at one time.
Signs and symptoms

You might not have any signs or symptoms at first.

Early signs and symptoms may make you feel like you
have the flu. Common signs and symptoms happen
during each stage of an acetaminophen overdose. If
the overdose is treated right away, you might have
fewer or easier symptoms in the later stages.
 First 24 hours:Nausea, vomiting, stomach pain, and loss
of appetite
Paleness
Tiredness
Sweating
24 to 72 hours after the overdose, you may also have any
of the following:Pain in your upper right side
Dark urine
Urinating less often than usual
Skin and the whites of your eyes turn yellow
 72 to 96 hours after the overdose, you may also have any of
the following:Blood in your urine
Fever, lightheadedness, or fainting
Fast breathing or trouble breathing
Extreme weakness or tiredness
Feeling very hungry, or shaking
Blurred vision, a fast heartbeat, or headache that will not go
away
Trouble staying awake
Confusion
Coma
How is an acetaminophen overdose
diagnosed?
The serum acetaminophen concentration is the basis for
diagnosis and treatment. A diagnostic serum concentration
is helpful, even in the absence of clinical symptoms, because
clinical symtpoms are delayed. The Rumack-Matthew
nomogram interprets the acetaminophen concentration (in
micrograms per mL), in relation to time (in hours) after
ingestion, and is predictive of possible hepatotoxicity after
single, acute ingestions of acetaminophen.
Recommended serum studies are follows:
Liver function tests (alanine aminotransferase [ALT], aspartate
aminotransferase [AST]), bilirubin [total and fractionated], alkaline
phosphatase)
Prothrombin time (PT) with international normalized ratio (INR)
Glucose
Renal function studies (electrolytes, BUN, creatinine)
Lipase and amylase (in patients with abdominal pain)
Serum human chorionic gonadotropin (hCG) (in females of childbearing
age)
Salicylate level (in patients with concern of co-ingestants)
Arterial blood gas and ammonia (in clinically compromised patients)
How is an acetaminophen overdose/poisoning
treated
Acetaminophen overdose is a serious problem.
Treatment should be started as soon as possible.
Treatment depends on how much time has passed
since the overdose and if the overdose happened all
at one time. You may be given activated charcoal
medicine to soak up the acetaminophen that is still in
your stomach. Activated charcoal will make you vomit.
Gastric lavage may be needed to clean out your
stomach to get rid of the acetaminophen.
 Gastric lavage is also called having your stomach
pumped. You may be given antidote medicine to
stop the effect of the overdose. You may also be
given medicine to slow down the effects of
acetaminophen
How can an acetaminophen poisoning be
prevented?
Read labels carefully. Read the labels of all the
medicines you take. If your medicine contains
acetaminophen, it will be listed in the active
ingredients section. Acetaminophen may be listed on
the label as APAP, Acetaminoph, Acetaminop,
Acetamin, or Acetam. Check carefully to see if the
acetaminophen is a regular or extended-release form.
 Do not take more than 1 type of acetaminophen at a
time. Many combination medicines contain
acetaminophen. Make sure the total dose of
acetaminophen you take is not more than 4,000
milligrams (4 grams) in 1 day. Ask your healthcare
provider if you are not sure how much you are taking.
Check other medicines to see if they contain
acetaminophen. Do not take these medicines
together with acetaminophen. The combined amount
of acetaminophen may be too much.
 Take the correct dose. Make sure you take the right amount
and wait the right number of hours between
doses. Never take more than the label says to take. Do not
take acetaminophen for more days than directed. If the
medicine came with a device such as a spoon or dropper, use
it to measure your medicine.
Do not take acetaminophen for too many days in a row. Do
not take acetaminophen for more than 10 days to treat pain,
unless your healthcare provider tells you to. Do not take
acetaminophen for more than 3 days to treat a fever, unless
your healthcare provider tells you to. Your pain or fever may
need to be treated another way if it lasts longer than a few
days.