Acetaminophen overdose can cause liver damage. This damage occurs in a
dose-related manner, which means, the higher the dose, the worse the
damage. Acetaminophen overdose is the leading cause of acute liver
failure in the U.S. If the drug taken in the appropriate quantity, no damage
occurs; however, it is when the dosage exceeds 4 grams or 8 extra strength
pills that the damage is likely.

How does the damage occur?

Liver damage occurs when one of the pathways in the liver is weighed
down by too much acetaminophen metabolite, which is called NAPQI. As a
result, the toxic compounds build up and cause damage. This buildup
causes the Cytochrome P-450 system in the liver to become overactive.
And once again, this increases the formation of NAPQI. The extra NAPQI
cant be detoxified and this in turn causes the liver to be damaged.

 Accidental or intentional?

The cause for one third of the overdoses of acetaminophen is intentional,
and the other two thirds is accidental. Usually people are not aware
that a drug like this can cause serious effects and end up taking a much
higher dose or more doses within a 24 hour period.

 How does the damage occur?

The overdose damages the liver in three stages. During the first stage,
the S&S might be nausea and vomiting. During the second stage, which is
called the latent stage, the patient may feel perfectly fine. However,
during the third stage, when liver lab tests are performed, liver
function is noted to deteriorate.

 What should you do if toxicity is suspected?
If acetaminophen toxicity is suspected, one should contact a doctor and
take all the bottles of medications so the doctor can evaluate the
severity of the injury. At this point, the doctor may pump the stomach
to remove the leftovers of the pill so the injury cannot be worsened.

Tylenol is thought to be an acceptable painkiller if it is used in the
dose that is safe. However, according to Lauran Neergaard of the
Associated Press Medical Writer, “Consumers often swallow a few extra
pills in hopes of faster pain relief, falsely thinking that
over-the-counter medications are safe enough to push the dose.” This
kind of thinking is detrimental because Tylenol is not safe when used at
this high of a dose or this frequently.

New Testing for Acetaminophen Overdose

Acetaminophen toxicity is the leading cause of liver failure in the United
States, according to the Center for Disease Control. Acetaminophen can be
found in pain relieving drugs and is safe if used at the recommended dosage.
However, when misused with alcohol or taken in excess it can lead to liver
failure and even death.

Currently acetaminophen toxicity is determined by taking a blood sample of
an individual and measuring for elevated levels of acetaminophen in the
blood. This must be done within 24 hours of a suspected overdose, due to
the fact that acetaminophen is only present for 24 hours after a large
overdose. In the past when patients were admitted in the hospital for liver
damage with undetermined causes, leaving doctors baffled to the cause of
the liver damage.

According to the University of Arkansas for Medical Sciences, researchers
have developed a more effective diagnostic test for acetaminophen
poisoning. The test relies on protein markers found in the blood that can
detect acetaminophen poisoning effectively to determine whether the liver
damage is related to acetaminophen.
A study conducted by Jack A. Hinson, Ph.D., a professor in the UAMS
Department of Pharmacology and Toxicology, discovered that out of 64
individuals who had undetermined causes of liver damage, 8 were found to
have had acetaminophen overdose as the cause. The protein adduct test is
effective in helping make better diagnoses and also in helping improve and
educate to prevent future incidences of acetaminophen overdoses

When acetaminophen is used in the correct doses and under the right circumstances, it is considered very useful and safe. However, people accidentally overdose themselves when combining it with other medications that contain acetaminophen in them. Heavy drinkers who mix acetaminophen with alcohol or people who consume less food than necessary are at risk for acetaminophen toxicity. Acetaminophen toxicity occurs when acetaminophen is not processed quickly enough. Therefore, too much acetaminophen is left in the blood and filters through the liver causing damage. This can lead to liver damage, liver malfunction, and/or death!

Why is this a “hot” topic?

The public is unaware of how common acetaminophen is found in over-the-counter drugs. About 100 deaths per year and last year alone, 56,000 emergency room visits are due to acetaminophen overdose, as noted on Tylenoldanger.com. According to the National Institute of Health and the Center for Disease Control, acetaminophen toxicity is the leading cause of acute liver failure in Americans.

Why should we educate ourselves?

First, acetaminophen is found in more than 600 over-the-counter and generic drugs. Therefore, the combination of any of these drugs can easily cause acetaminophen toxcity without the consumer knowing. Second, the label on the bottle does not warn consumers of the possible dangers associated with high doses, long term usage, and combining drugs containing acetaminophen.

Tylenoldanger.com stated that the FDA has proposed to changing the warning label from “If you consume 3 or more alcoholic drinks every day, ask your doctor whether you should take acetaminophen or other pain relievers/fever reducers. Acetaminophen may cause liver damage.” to “The risk of liver damage increases if you have three or more alcoholic drinks while using acetaminophen.” This would be done in efforts to warn consumers of the risks involved when combining acetaminophen and alcohol.

Treatment and Prevention of Acetaminophen Toxicity:

To prevent incidents of overdose, we should always read the labels of all the medications we are taking. We should make sure not to combine Tylenol with more than three alcoholic drinks in a day.

When acetaminophen toxicity is unrelated to alcohol, the drug acetylcysteine is used for treatment. It can be used intravenously or more commonly through a nasogastric tube.

Links http://www.tylenoldanger.com/html/liver.html

http://www.tylenolprofessional.com/tylenolprofessional/safety–safety-by-system.html

 People who take Tylenol and other medicines that contain
acetaminophen are largely ignorant of the safe dosages and unaware that
an overdose can cause severe liver damage. The article of a survey
appears in the January/February issue of The Journal of the American
Pharmacists Association has found out of 104 consecutive patients at a
Michigan clinic, almost 80 percent reported using acetaminophen in the
previous six months, but about 63 percent were unsure whether they had
been told about the dangers of high doses. Only 43 percent knew that
the medicine could affect liver function. Studies cited in the article
report that overdoses of acetaminophen are the most common cause of
acute liver failure in the United States. According to Medicinenet.com,
Americans take over 8 billion pills (tablets or capsules) of Tylenol
each year. The National Hospital Discharge Survey (NHDS) indicates that
there are an average of 26,256 hospitalizations per year related to
acetaminophen overdoses.

NCBI Pub Med, a service of the U.S. National Library of Medicine
and the National Institutes of Health, reports that acetaminophen (APAP)
is the most common drug overdose in pregnancy. APAP has been
demonstrated to cross the placenta. Fetal hepatocytes metabolize APAP
into both active and toxic metabolites. These toxic metabolites may
cause fetal hepatic necrosis, resulting in morbidity and mortality.

Acetaminophen is one the most common and frequently used OTC drugs, known as
Tylenol. It is also present other medications like anacin-3, liquiporin, panadol, tempra,
and various other cold/flu medications. So, toxicity can easily occur when combining
Tylenol with such medications or overdosing it, because people usually do not read the
labels carefully and are unaware that acetaminophen in present in many other
medications. Acetaminophen overdose can lead to serious consequences like liver
damage and death.

Regulated by the FDA
FDA is concerned about the incidents of acetaminophen overdose in the recent years and
placed regulations on companies to place labels about acetaminophen content in all
medications.
Dr. William Lee of Texas Southern Medical Center in Dallas, in his survey tracked 300
cases of acute liver failure at 22 hospitals to which 38% was linked to acetaminophen
overdose.

Causes

A. Taking acetaminophen in combination with more than 3 alcoholic drinks a day.

B. Varying dosing schedules and formulations of recommended drug in infants and         
   children.

 C. Combining it with other medications that contain acetaminophen as one of their drugs.

Signs and Symptoms:
Initial symptoms may be flu-like, so doctors may not be prompt for overdose treatment.
Other symptoms include -sudden fever, nausea and vomiting, abdominal pain, diarrhea,
irritability, jaundice, sweating, coma, and/or convulsions.

Treatment

Symptoms do not occur until 12 or more hours after acetaminophen consumption.:
Require immediate assisteance to the emergency, within 8 hours.

Prognosis
If not treated, overdose can lead to LIVER FAILURE and DEATH.