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Tylenol toxicity? How serious?? Please read!

hi ER nurses. my sister apparently tried to overdose on tylenol PM or was taking it too much over a few days maybe to help her sleep. she is in the ER right now and the docs told my BIL that she has toxic amounts of tylenol in her system and that she may have liver damage, they are giving her n-acetylcysteine and are going to keep her in the hospital for 2 days at least. they told my BIL that she may still die.

is this true? any info you could give me? she is in florida and i am in arizona and it is so hard to not be there. thanks.

Tylenol can damage the liver yes and if you damage the liver enough it can stop working and the body can shut down.eventually.......so yes it is possible. When I was 13 yo I ODed on Tylenol and I had a close call too. The doc was angry at me and told me I could have died. I'm not saying your sister can die. It depends on all kinds of factors such as the acetaminiphen level and how much it rose after the initial testing....I have no idea how much she took and I hesitate to play soothsayer. I'm not sure how tylenol helps her sleep though and she would have had to take a huge amount over a few days for it to harm her badly if she were a young healthy woman.

Anyways ever since my incident I follow the directions.

I'll pray for you and your family today. Let us know what happens ok?

Z

thanks. she is in the ICU now and will be there for 2-3 days. i guess they will be running more tests in a few hours and will have more info then. she will be transferred to a psychiatric hospital after she is released from the hospital for mandatory 72 hours and maybe more there for treatment.

they found a suicide note, so it was intentional. i am just so sad that i didn't know how sad she was and that she wanted to die.

traumaRUs, MSN, APRN, CNS

Specializes in Nephrology, Cardiology, ER, ICU. Has 27 years experience.

Am so sorry about your sister. I hope she gets the help she needs. We now give Mucomyst IV which works much faster to pull the tylenol out and it is much better tolerated then oral dosing also.

mommatrauma, RN

Specializes in ER.

Tylenol OD can be very dangerous...The sooner she started the NAC the better...there are usually good results with that...The other concern though..is not just the tylenol, but the fact that it was tylenol PM...Benadryl can also be a dangerous OD...It acts similar to a tricyclic OD and can cause EKG changes. Hopefully your sister got prompt care and is getting the help she needs..good luck.

mommatrauma, RN

Specializes in ER.

Quote
Tylenol can damage the liver yes and if you damage the liver enough it can stop working and the body can shut down.eventually.......so yes it is possible. When I was 13 yo I ODed on Tylenol and I had a close call too. The doc was angry at me and told me I could have died. I'm not saying your sister can die. It depends on all kinds of factors such as the acetaminiphen level and how much it rose after the initial testing....I have no idea how much she took and I hesitate to play soothsayer. I'm not sure how tylenol helps her sleep though and she would have had to take a huge amount over a few days for it to harm her badly if she were a young healthy woman.

Anyways ever since my incident I follow the directions.

I'll pray for you and your family today. Let us know what happens OK?

Z

A single dose of 10gms (20 Extra Strength pills) in a healthy non-alcohol consuming person can cause significant liver damage if not treated in a timely matter.The toxic dose of acetaminophen is highly variable. In adults, single doses above 10 grams or 140 mg/kg have a reasonable likelihood of causing toxicity. In adults, single doses of more than 25 grams have a high risk of lethality. Toxicity can also occur when multiple smaller doses within 24 hours exceeds these levels, or even with chronic ingestion of smaller doses.

rjflyn, ASN, RN

Specializes in Emergency. Has 23 years experience.

As the other posters noted about there are alot of depends. The sad thing is Tylenol/its generic is a quite effective suicide drug. I can be taken cause some nausea and vomiting and then the person feels good for a few days. Then the liver toxicity symptoms hit. How well someone recovers is dependant on the liver damage that occurs, when tx starts, what kind of health the person was in prior ie are they alcoholic and how effective that treatment is.

Fortunately it is rare that the person doesnt seek treatment soon after the ingestion. For that reason alot of times the person is getting admitted before a 4 hr level is known so its hard for me to comment on how many actually get the antidote and even more how many get it for its full course. I do know from having worked at a University affilitated hospital (level 1) that we saw one or two pts a year through the ED that ended up needing an emergent liver transplant to survive.

To be specific about a particular case would be hard. For your sisters sake she needs to be a a facility that has a Hepatologist that has delt with cases like hers.

Our prayers are with you

Rj

Intoxication with tylenol is really danger but if you can recognaized that on a first hours patient can survive and past without any seriouse damage that is truth because we hade the same cases aweek ago and the patient after a treatment on ER she even didn't have a need to stay at the hospital she whent home.

Thank you everyone for sharing your expertise. my sister is getting the mucomyst nasally still and since they don't know how many she took or what time she took them, they can't really say what is going on (she won't tell them, is upset that they stopped her from succeeding, but apparently being polite, etc).

They did say something about the LFTs not peaking or rising, not sure. all the info is through my BIL who is stressed and has no medical knowledge. he said she is vomiting quite a bit and apparently they have talked about possible liver damage because he asked me what the liver actually does and what damage could do, etc.

Thanks again for your info and well wishes. I think her spirit is in need of more help than her body, since she is in the hands of doctors and nurses who are doing all they can given the info they have.

Hi everyone. It looks like she took 30 extra strength tylenol pms (15 gms) at 5pm and didn't get the mucomyst started until 2am that night. I spoke with her ICU nurse today and she told me that she isn't doing as well as she should be.

Apparently they are administering it via NG tube and she keeps vomiting it up, antiemetics aren't helping her to not vomit. She had low urine output today and had some episodes of ventricular bigeminy on her EKG today. They were going to run electrolytes to see if she had imbalances that were possibly causing it that could be corrected, but I don't know anything of those results. they gave her something to see if they could increase urine output or to find out if her kidneys are shutting down.

I keep waffling between trying to get there to see her or not. Apparently she only gets a few visiting periods a day for 30 minutes and from 9pm to 9am can have no visitors, not even her husband. I don't even know that I would get there and be able to see her. they won't let her talk to me on the phone either. Very frustrating. her day nurse was very informative and nice, but the night nurse was not.

I keep hoping she will be okay, but reality looks different. she is supposed to call me in the morning from her cell phone and I will see how things look and possibly drive there.

Thanks for all the info. it is scary to know the possibilities, but better than sitting here wondering and trying to find into online. it is so not my area.

Would appreciate any other info you might offer. thanks.

You should definitely go see her. It will be good for both of you and of course we let immediate family in the ICU. Best of luck. (Oh, and we don't let anyone use cell phones in the ICU)

DDRN4me

Specializes in pedi, pedi psych,dd, school ,home health.

{{{{{hugs))))) no advice other than to go see her for both of your sakes....my thoughts and prayers are with you and your family.

My prayers are with you and your family. It's a terrrible thing to go through and I'm sure you're havng some very mixed emotions right now. Hugs.

traumaRUs said:
Am so sorry about your sister. I hope she gets the help she needs. We now give Mucomyst IV which works much faster to pull the tylenol out and it is much better tolerated then oral dosing also.

Ugh....they punished me. I had to drink it with Coke.

traumaRUs, MSN, APRN, CNS

Specializes in Nephrology, Cardiology, ER, ICU. Has 27 years experience.

It's only recently been approved to give IV - much better tolerated! I probably would also go. We have much more lenient visiting policies - I am a strong advocate of family presence and feel it is a good thing. Take care.

hello everyone. i spoke with her for a minute this morning and she is going to call me back later. it was nice to hear her voice. not sure if i will be going to see her yet, waiting to talk to her again shortly.

they do NOT seem lenient with ICU visits there at all. her husband can barely see her and from 9pm till 9am she can't have visitors. not very family friendly. when my dad and i called 2 times each, both of us far away and obviously upset, they couldn't even facilitate a quick phone call so we could say hi to her. they said they could pass on the message that we called. that sucks.

anyway, not sure if i will be asking her any medical info, just what she offers. i am actually a little scared to talk to her, for fear of saying the wrong thing. think i will stick to i love you and i hope you are okay.

for whatever reason, despite the repeated vomiting, she was getting the mucomyst orally via NG tube the whole time. i guess they didn't have the IV kind there or don't use it for whatever reason. she was vomiting everytime they gave it to her, the nurse told me she just couldn't keep it down which was another reason she was worried about her progress, since she possibly wasn't getting the mucomyst. makes me frustrated they didn't get it IV. i wonder why?

breastfeedingRN said:
thanks. she is in the ICU now and will be there for 2-3 days. I guess they will be running more tests in a few hours and will have more info then. she will be transferred to a psychiatric hospital after she is released from the hospital for mandatory 72 hours and maybe more there for treatment.

they found a suicide note, so it was intentional. I am just so sad that I didn't know how sad she was and that she wanted to die.

Sorry about this distressing situation. Very upsetting! God Bless your family.

Altra, BSN, RN

Specializes in Emergency & Trauma/Adult ICU.

So sorry to hear of your family's situation ... will keep you all in my thoughts.

anyone know how long you have to get a liver transplant when your liver is going bad?

Hi We are so sorry to hear about that she isnt well also today but I think is a bitt early to see the effect sides but you have to be strong and to dont lose a faith, she will be ok soon she is young and will survive dont worry.

Hoppe to hear from you and your family good news on the future

take care

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