Had a Pt this week who routinely takes 8000mg of Tylenol a day.

gwenith, BSN, RN · Aug 14, 2004

Compensation - like a lot of organs the live may not show altered functioning until a certain amount of damage has been done.

leslie :-D · Aug 14, 2004

did the doctor change her analgesic regimen to something other than acetaminophen?

RNBSN1 · Aug 14, 2004

When I informed her docter of this practice he ordered liver function tests. Would you believe that they came back normal? I could not believe it!!! How in the $%#* is that possible?

Huh?????????????????????????????????????????????????

sweetcheekers · Aug 14, 2004

did the doctor change her analgesic regimen to something other than acetaminophen?

I don't know what his plan was. He didn't put her on the Tylenol in the first place. She was self medicating for Fibromyalgia. I told her that she needed to speak with her doctor about other options because this was highly dangerous to her health. I told her that I would be informing him of the amount of Tylenol she was using so she wouldn't blow it off and not ask him about other options. I'm sure he will follow up on it because as soon as I told him about the excessive use of it he wrote an order for Liver function tests immediately and without hesitation. I almost wondered if he was going to believe me when I gave him the numbers. The woman had this supersize bottle with her in her room so I sent that home with her daughter.

leslie :-D · Aug 14, 2004

i certainly hope this poor woman gets the relief she is so desperately seeking.

dang.

Trauma Columnist · Aug 14, 2004

Since the toxic level of tylenol is 144mg/kg - as long as she weighed more than 55 kg and had normal liver function - she should be okay for a few days. However, this is way too much tylenol. She needs a pain clinic referral.

Blackcat99 · Aug 14, 2004

When I informed her docter of this practice he ordered liver function tests. Would you believe that they came back normal? I could not believe it!!! How in the $%#* is that possible?

Wow! This is unbelievable! Hope this doctor will figure out a better solution for pain relief.

CardioTrans, BSN, RN · Aug 14, 2004

Wow. I truly hope that she has help finding something to relieve her pain.

About 2 yrs ago, my dh partner called and said that he wouldnt be at work, that his wife had been admitted to the hosp. They had recently been to New Orleans and thought that her symptoms were from seafood she had eaten. 3 days later she became jaundiced, they transferred her to the major teaching hosp and 2 days later she went into a coma. One by one her systems shut down. They had placed her on life support then a wk later her EEG showed no activity at all. All life support was removed and she died. She was only 29. They sent a biopsy of her liver to Johns Hopkins and found that it was liver failure related to acetamenophin. Her husband then realized the amount of Tylenol that she took on a daily basis. 4 at a time, 4-5 times a day and had been taking this for about 6 months for joint pain. She had been telling him that she only took a couple every now and then. She left behind her husband, a 10yr old daughter and a 2 yr old son.

Heres hoping the docs will be able to help your patient.

jnette, ASN, EMT-I · Aug 14, 2004

Our youngest dialysis patient (30) is on permanent dialysis due to his overconsumtion of ibuprofen.

If not the liver, then it can certainly damage the kidneys.

sweetcheekers · Aug 14, 2004

Wow. I truly hope that she has help finding something to relieve her pain.
About 2 yrs ago, my dh partner called and said that he wouldnt be at work, that his wife had been admitted to the hosp. They had recently been to New Orleans and thought that her symptoms were from seafood she had eaten. 3 days later she became jaundiced, they transferred her to the major teaching hosp and 2 days later she went into a coma. One by one her systems shut down. They had placed her on life support then a wk later her EEG showed no activity at all. All life support was removed and she died. She was only 29. They sent a biopsy of her liver to Johns Hopkins and found that it was liver failure related to acetamenophin. Her husband then realized the amount of Tylenol that she took on a daily basis. 4 at a time, 4-5 times a day and had been taking this for about 6 months for joint pain. She had been telling him that she only took a couple every now and then. She left behind her husband, a 10yr old daughter and a 2 yr old son.
Heres hoping the docs will be able to help your patient.

All I can say is WOW! Unbelieveable. It goes to show how uninformed people can be. I am as guilty as any of minimizing the potential harm of OTC meds. Not anymore. (Amazing how nursing school puts a different slant on things.) More and more I'm seeing the importance of patient education.

sweetcheekers · Aug 14, 2004

Since the toxic level of tylenol is 144mg/kg - as long as she weighed more than 55 kg and had normal liver function - she should be okay for a few days. However, this is way too much tylenol. She needs a pain clinic referral.

Actually, she only weighed 48 kg and had been doing this for months if not years. She said she takes 2 500mg caplets at a time every few hours. I said, "Tell me how many times in a 24 hour period do you take this amount on a typical day?" She said, "8 times." I swear my jaw about hit the floor. Interesting Pt. In for cellulitus of finger, hx of fibromyalgia, subtotal gastrectomy r/t ulcer, hysterctomy in early 40's for endometriosis. Weird thing is she was on a PCA for this inflammed finger gettin 10mg demoral with a 6 min. lockout and a maximum of 240 mg q 4 hours. The lady had used 100 mg in 8 hours and was becoming overly sedated. Upon assessment I found she had pupils at 2 mm and barely reactive, respirations had dropped from 16 to 12 in five hours and pulse ox was 91% on room air. She also was getting Toradol 30mg q 8 hours IV. Her pain level was always at a 4. It never changed all day long. She could be aroused but would fall asleep right away if not stimulated with verbal cues. Anyway, reported to doc the problems I was seeing and they lowered the PCA dose. Next day she had not used PCA in 8 hours and pain was at a 2 in the AM and 1 in the afternoon. Go figure!