Tylenol toxicity? How serious?? Please read!

Specialties Emergency

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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.

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.

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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.

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Specializes in Nephrology, Cardiology, ER, ICU.

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.

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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?

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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.

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Specializes in Emergency & Trauma/Adult ICU.

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

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

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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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well, her doctors told her today that she might need a liver transplant. the nurse told me that they have to check her liver enzymes tomorrow again and that they just don't know. they have ordered a GI consult and she mentioned the possibility of her needing a liver transplant. she is about 44 hours post ingestion now.

her nurse said that overall she looks better today, more talkative and her heart stuff resolved (my sister mentioned to them she had feeling of palpitations before this happened) and her urine output is good. bilirubin is high and so are her enzymes. she has stopped vomiting and they still have about half the doses left to give of the mucomyst. they might remove NG tube if she can tolerate drinking the mucomyst herself.

i am hoping her liver starts to recover itself in the next few days. she will not be at the top of the list because she attempted suicide and also had some cocaine in her system. i understand this, but it doesn't make it any easier from the sister side of me. i don't know if we would be a match, but i would have to try to give her some of my liver if we were, though i am terrified of not making it though because of my almost 3 year old. not even sure if her insurance covers transplants, so who knows.

thanks to everyone who has responded. you can all imagine how helpless i feel and information is power. even if it is not good news, it is better than false hope.

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Specializes in Vents, Telemetry, Home Care, Home infusion.

Sending you a {{{{{{{{{{hug}}}}}}}} to get you through the days ahead.

prompt treatment within 8-10 hours of ingestion, usually have no liver damage. slightly more concerned as she took tylenol pm which has both tylenol and benadryl as ingredients. I've only experience with straight tylenol od and with treatment, given lots of mucomyst mixed in cola syrup to get it down. old days all our COPD patients got mucomyst mini nebs--learned real fast to tolerate that rotten egg smell ;)

Helpful links:

"If a patient is treated within 10 hours of acetaminophen ingestion, the risk of hepatoxicity is low"

https://academic.oup.com/ajhp/article-abstract/56/11/1081/5150344

On the basis of available data, the 72-hour regimen of oral n-acetylcysteine is as effective as the 20-hour intravenous regimen described previously, and it may be superior when treatment is delayed.

https://www.nejm.org/doi/full/10.1056/NEJM198812153192401

https://emedicine.medscape.com/article/820200-overview

https://emedicine.medscape.com/article/820200-overview

If possible, get on a plane and go see her. Having delt with similar situation that personal hug can be a great motivator.

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Specializes in Telemetry, ICU, Resource Pool, Dialysis.

(((((((((((BreastfeedingRN))))))))))))) I'm so sorry about what's going on. It is SO hard to be so far away and feel like your hands are tied. Do you feel that she is in a good hospital? With competent doctors and staff? Does her husband have any concerns about her care? If you answer yes, yes, no - you need to take a deep breath and let things take their course. You can't change anything, even if you were there. But I think you should ask her if she would like you to visit - and if it's possible, and she wants it, you should go.

I've only been in ICU 3 years, and have seen several tylenol ODs. Only 1 went badly - and that was because she was given charcol in the ER while very lethargic, and aspirated. I saw a young lady with a very high level recover without any complications, very quickly. Most of the ODs I've seen were not that serious (they didn't take very much, or their levels did not reflect the amount they said they took). You are very much in a wait and see situation. I know you know this already - but I've been in your situation, and I know what you are probably going through. It's very difficult to be in this situation as a nurse, feeling like you need to have the answers, and fix things.

On a personal note - and maybe as reassurance - when I was 15, I took around 25 ES Tylenol ( an entire small bottle), with alcohol - and didn't tell anyone. I was sick all night, and the next day - vomiting and visual disturbances, and physical sensations ( I remember vividly). I felt better the next night. I never did tell anyone - just decided that there must have been a reason I lived. I still can't bring myself to take tylenol - just looking at the bottle makes me nauseated. Anyway, I survived and as far as I know, my liver is fine.

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nruse karen and prickly pear,

thanks for the encouragement and the support. those articles were very informative and encouraging. maybe they are just trying to prepare them for the worst and we should really still just be calm and wait to give the medicine a chance to work. i really hope so.

she is in west florida hospital in pensacola. don't know their reputation. i think they would have preferred a different hospital, but that is closest to their house and that is where they are. her day nurse the past 2 days is great. very nice and informative, with me after i gave her the "code" and with my sister's husband as well. he wasn't thrilled with the night nurse, came in because they were a little over visiting hours and said they had to leave right then.

i guess all ICUs are the same, but she can't see her kids. they don't know she tried to OD, just that she is sick. they are with their grandparents.

i am going to keep praying and hope for the best.

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