Be Vigilant About Acetaminophen (Tylenol) Toxicity
Acetaminophen (Tylenol), one of the most popular medications in the world, is used for the treatment of pain and fever. However, acetaminophen toxicity can lead to acute hepatic failure and the possible need for liver transplantation. The purpose of this article is to discuss acetaminophen toxicity.
Acetaminophen, a medication used for the relief of pain and fever, is a common staple in medicine cabinets around the world and can be found in both over-the-counter (OTC) and prescription formulations. Outside of North America, acetaminophen is better known by the name paracetamol. Even though the brand Tylenol is the most popular acetaminophen-containing product, more than 200 other medications also contain this drug.
When taken at recommended doses, acetaminophen is usually safe and effective. However, this medication can be deadly when too much is taken. In fact, acetaminophen toxicity is the leading cause of acute hepatic failure in the industrialized world. Acetaminophen toxicity is the most common cause of hepatic failure requiring liver transplantation in Great Britain (Farrell, 2012). The majority of overdoses in the US, the UK, Australia, and New Zealand involve acetaminophen. In the United States, APAP toxicity has replaced viral hepatitis as the most common cause of acute hepatic failure and is the second most common cause of liver failure requiring transplantation (Farrell, 2012).
The signs and symptoms of acetaminophen toxicity are experienced by patients in three distinct stages. Many patients display no signs or symptoms of acetaminophen toxicity during the first phase, which is the initial 12 to 24 hours after the overdose. Some patients will experience general complaints such as malaise, nausea, vomiting, mild abdominal pain, and perspiration within a few hours after the overdose. For the next perhaps 12 to 24 hours, which is the second phase or the so-called inactive (latent) phase, the patient feels well (Lee, 2007).
During the third phase, which starts between 48 to 72 hours after the overdose, abnormal hepatic blood levels can be detected. Patients may continue to experience nausea and vomiting while beginning to experience right upper quadrant pain. Hepatic necrosis and dysfunction are associated with jaundice, coagulopathy, hypoglycemia, and hepatic encephalopathy (Farrell, 2012). Acute kidney failure sometimes develops during this third stage; in addition, some patients develop multiple organ failure and die.
For the average healthy adult, the recommended maximum dose of acetaminophen over a 24 hour period is four grams (4000 mg) or eight extra-strength pills (Lee, 2007). However, the patient who consumes more than two alcoholic beverages per day should not take more than two grams of acetaminophen in a 24-hour period. Any patient who has overdosed on acetaminophen must obtain prompt medical attention because interventions are most effective within the first eight hours after the last ingestion.
In addition, a Boxed Warning highlighting the potential for severe liver injury and a Warning highlighting the potential for allergic reactions (e.g., swelling of the face, mouth, and throat, difficulty breathing, itching, or rash) are being added to the label of all prescription drug products that contain acetaminophen (FDA, 2011).
Be sure to inform your patients that many OTC products contain acetaminophen, and reinforce to them that it may appear on the label as 'APAP.' Many patients are unknowingly taking multiple medications that contain acetaminophen, which can be dangerous. If we arm them with this knowledge, they can take the steps necessary to stay safe and prevent harm caused by overdose. Knowledge is power!
She was a CNA who worked for the facility, then she got her RN and went straight to the 3-11 house supervisor position. A position that's all staffing and administrative duties. No actual bedside nursing in-between.
It sounds like she has no common sense and apparently did not learn anything in school.
Tylenol, if not aspirin, is the first drug you learn about d/t it being so common.
Way to go (!!) for your facility for setting the Peter Principle in motion ASAP!
Specializes in Gerontological, cardiac, med-surg, peds.
In the pediatric population, one needs to especially be on guard for acetaminophen toxicity. Parents mixing up the dosages of Tylenol Infant Drops and Children's Tylenol resulted in tragic cases of liver failure and death in their children. The infant drops at 80mg/mL had nearly 3 times the concentration of the Children's Tylenol at 32 mg/mL.
"My good friend knows a man who found his brother after a suicide attempt with Tylenol.
It took this poor kid a week or so to die.
He regretted what he had done-- didn't want to die after all...
Nothing to do but wait and die.
Dear god."
I read this and got chills. Back in 2006, I was in a really low place. As stupid, young, and reckless 19 year old, my newly married husband and I got into a massive fight, and to get back at him and "stop the pain" I intentionally overdosed on 24 extra strength tylenols. I wanted to die, or so I thought.
I should be dead, but I thank God that he spared my life. I had no idea what would actually happen to my body if I overdosed. Just thought it would kill me off quickly--put me to sleep or something like that. After multiple hours of nothing, (taking 13 extra strength), I went to the pharmacy, bought a new bottle, and took 11 more. Went to work, let a few more hours pass by, and then, FINALLY, started to get second thoughts.
I tried so hard to induce vomiting, but nothing came back up. At the hospital, I remember bits and pieces...fored to eat charcoal and vomiting it up 3 times before an NG tube was placed. Not pleasant. IVs like nobody's business running acetylcysteine.
The paramedics and doctors were all amazed that I walked away from this at all, considering how long I waited to cave. I got lucky. No liver damage at all! But a stern warning that if I ever have tylenol again, my body will immediately move into liver failure.
I hope and pray that as a nurse I will get a chance to give someone else the opportunity to live through their stupid reckless decisions, as the nurses and doctors who came to my rescue did for me.
Specializes in L&D, CCU, ICU, PCU, RICU, PCICU, & LTC..
Rather than risk toxicity, why not alternate pain meds?
I take Tylenol rarely after having a 23 y/o in 1975 die in ICU from taking it for cramps. Have never trusted it since.
I have had Lortabs, Percodan, Oxycodone, Ibuprofen, aspirin and Robaxin in varying doses.
If I have a quiet day planned, I may take just 200mg of Ibuprofen or nothing at all, a moderate day I may take 2 aspirins with 600 Ibuprofen or 500mg of Robaxin. On my busy days or more painful (like shopping & cleaning or bad weather) I may take something to start and then in an hour take an oxy 15mg, or 2 oxys 30mg if I know I am going to have trouble.
With this, I have been on narcotics PRN since 1984 and have not become tolerant of my meds nor have I become addicted to any.
I don't think the pharm. industry has done enough to alert consumers about acetaminophen toxicity. Another real and related problem is addiction to acetaminophen/caffeine/aspirin OTC pain meds. Some people use them day after day for extended periods of time but the pharm. company said they should be used no more than 10 days. Prolonged use causes severe rebounds symptoms and can be difficult to stop. My 82 year old mother has kidney problems after using six tablets a day for 20+ years. She had no idea it would cause permanent damage. Several years ago she stopped taking it for a week because she was scheduled to have surgery but she didn't make it to surgery. She suffered a heart attack when her blood thickened from stopping the large dose of aspirin/tylenol suddenly.
A question for all, my facility recently changed the standard for max Tylenol dosing from 4 G/24 hrs to 3 G/24 hrs supposedly based on new federal guidelines. I don't think it is a bad idea, but has anybody else heard of this or made this change where you work?
I have heard of the 3g recommendation, but at my hospital, it's still 4g. It amazes me how many nurses don't even really know what class of drug tylenol is. I was giving report to another RN who was precepting a new grad. The pt had previously complained of pain and was ordered a one time dose of percocet, but refused the med because of the narcotic. In the evening, pt was complaining of pain again, so I called and got an order for tylenol, which the pt took with good results. The new grad listening to report jumped in to chastise me for ordering tylenol for this pt. Why? Because the pt had a hx of GI Bleed. For a second, I just stared at her, but after a moment, it hit me, so I asked her, "Do you think tylenol is an NSAID?" Her reply was that it is an NSAID and that it was irresponsible of me to get it ordered for this pt. Her tone and attitude left me wanting to share a few choice words with her, but I took a deep breath and told her, "No, tylenol is not an NSAID; you are welcome to look it up, which you probably should, since you obviously don't know what class of drug it is, but I'll just let you know that I'm right."
The scary thing for me was that this wasn't the first time I had had another RN tell me that tylenol is an NSAID.
heard of it, think the pharm is talking about it, and I think it is actually 2600 for the elderly, which would work out to 2 doses of tylenol arthritis...
kbrn2002 said:
A question for all, my facility recently changed the standard for max Tylenol dosing from 4 G/24 hrs to 3 G/24 hrs supposedly based on new federal guidelines. I don't think it is a bad idea, but has anybody else heard of this or made this change where you work?
Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
kbrn2002 said:
A question for all, my facility recently changed the standard for max Tylenol dosing from 4 G/24 hrs to 3 G/24 hrs supposedly based on new federal guidelines. I don't think it is a bad idea, but has anybody else heard of this or made this change where you work?
Yes. The 24-hour limit of acetaminophen was recently decreased from 4 grams to 3 grams at my workplace.
Hygiene Queen
2,232 Posts
It sounds like she has no common sense and apparently did not learn anything in school.
Tylenol, if not aspirin, is the first drug you learn about d/t it being so common.
Way to go (!!) for your facility for setting the Peter Principle in motion ASAP!