overdose, acetaminophen

Overdosage with the pain and fever relieving drug acetaminophen (Tylenol® and others) is potentially very dangerous. Overdosage must be treated early and aggressively to prevent a severe complication of liver damage and even fatal liver necrosis.

Children can receive a potentially toxic dose of acetaminophen either by acute ingestion (eating a large number of chewable tablets or drinking the liquid preparations) or by chronic overuse of the medication for illnesses with persistent fever.

In acute ingestion situations - usually the parent finds the child with an empty bottle of pills or liquid medicine all over the face, the shirt and the floor - time is of the essence. Acetaminophen is very rapidly absorbed from the stomach and enters the bloodstream within about 30 minutes after ingestion. The sooner the child reaches the emergency room and therapy is begun, the better. Activated charcoal is administered orally to absorb as much of the medicine as possible so that it will pass harmlessly out of the body in the stool. A blood test will be done at about 4 hours after the ingestion, and the level of acetaminophen in the bloodstream determined. If it exceeds a critical level, then the child will begin a treatment regimen of an oral antidote (acetylcysteine, Mucomyst®). Acetylcysteine is very foul tasting and smelling, but potentially life-saving.

Chronic overdose situations can be more difficult for the doctor and parents to recognize. Symptoms of loss of appetite, nausea, paleness, and vomiting are early signs of liver injury, but these can be part of the patient's primary illness as well. Pain in the upper right abdomen is an ominous sign of more progressive toxicity. The best thing to do is to keep a record of how much fever reducing medicine is used over the course of any illness that lasts more than a day or two and requires medication for fever more than once or twice in 24 hours. Let your doctor know if you are having to give medication around the clock, or for more than two days. If you have to go back to the drugstore to get more acetaminophen because you have used up the first bottle, that is a sign of possible trouble. When in doubt, you should check with your doctor.

Keep the Poison Center number on your refrigerator! You can look yours up at the American Association of Poison Control Centers Home Page.

If you have to go to the emergency room in an overdosage situation, remember:
  • bring the bottle with you!
  • pick up any uneaten pills to be counted

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