Tylenol toxicity? How serious?? Please read!

pricklypear · Jun 16, 2005

I'm sorry about the lack of visiting hours in the ICU your sister is in. Hopefully, she will become stable enough to move to a regular room soon, that will improve the situation. We have to try to be strict with visiting, too. There are always exceptions - family member dying, confused pt, young person. Unfortunately, when we do allow exceptions, there are always the family members of other patients who say "How come he can stay and we can't?" I usually let my families know well in advance that we close to visitors at 10pm, so that allows them to leave on their own terms, instead of feeling "kicked out." It doesn't make it any easier for families who are concerned, though. In the end, I think it does some families good, though, as they get better rest at home. I always tell them to call anytime for an update, and that seems to help. Some families just need "permission" to go home and rest. They may feel they need to keep a virgil at the bedside.

Anyway, your BIL needs rest, too, to get through all this. I'm sure he is dealing with tons of emotions also.

I'll be thinking about you and your family.

PS - I think you're probably right about the doctors trying to prepare them for the worst case scenario. Sometimes people stop really hearing at "you may need a transplant" and don't hear the rest, like "if things don't continue to improve" or "there is a slight chance..." or "sometimes people who OD on tylenol need..." I'm sure you know what I mean!

Mystery5 · Jun 16, 2005

Oh, this whole story is very sad and distressing. I pray things will turn around with a happy ending.

nurse_wannabe · Jun 16, 2005

Yes, it is a terrible situation. I wonder why the hospital thinks it is good to keep a suicidal patient secluded from her family who loves her? It seems this is the time that she needs to be shown that love the most.

Please try to go see her, if at all possible. It will mean so much to her, I'm sure. I'm not asking you to share it with us, but do you have any idea why she would try to kill herself? If not, you really need to have a good talk with her and find out what is going on in her life.

My thoughts are with you. Please keep us posted. :icon_hug:

ZASHAGALKA, RN · Jun 16, 2005

Sorry to hear about your sister. You and she will be in my prayers.

I read an article recently about a drug researcher wanting to put NAC (mucomyst) in low doses within each Tylenol dose, to act as a first ward of antidote for overdoses. He did some research that said such a trick could extend the time to start of treatment without permanent liver damage and without significantly reducing efficacy.

Sounded good to me.

Unfortunately, Acetaminophen is such a dangerous drug (and worthless if you ask me) compounded by the fact that it's so common that people wrongly assume it's safe.

I've heard that in England (and I could be wrong about this), you can only buy acetaminophen in blister packs in limited amounts in order to prevent it being handy to use in overdoses.

The usual course is 17 doses, 4 hrs apart, or about 3 days. In my last hospital, ICU was the only place we could keep "suicide watches", so it's not just a simple matter of improvement in her physical condition: until she is 'psychologically cleared', she has to be where she can be constantly observed. And she can't be 'psychologically cleared' until she's first 'medically cleared'. It's a catch 22. I don't know about the rules in Florida, but that would have been the rule at the last place I worked. Just preparing you for the idea that she might be in ICU for awhile.

I think you should POLITELY approach the unit manager from the angle that, based on the severity of the situation, access to her children should be reconsidered due the potential for a negative outcome. Present it as a psychosocial need and the manager might be receptive. Let me be frank - if they are preparing you for the possibility that she might die, then what time she has available needs to be with her kids. If she improves, great, if not, it's a double travesty to those kids and the manager should recognize that. More liberal visiting for end of life (even if it's just a possibility at this point and lets prayer that it's not the case) is supposed to be the rule. Ask the manager to re-evaluate the patient advocacy of the situation in that light. But be polite.

If it comes right down to it, be assertive. If you've read any on this thread, we gripe alot about the 'customer service' model that is so often absurdly aimed at nurses. Well, use it to your advantage. Be your sister's patient advocate up the chain of administration. But NEVER raise your voice. Just be persistent.

It's a hard situation. Frankly, acetominophen sucks and I hate to see that kind of OD - it's the worse, because it's lethality takes time. The remorse and regret that it allows are the worst kind of tears that I've cried with patients.

~faith

Timothy

SmilingBluEyes · Jun 17, 2005

I am so sorry to read all of this ................what a terrible thing. I agree w/Karen. Try to get a flight and go see her, if you can. It would be good for you both. I will keep her in my thoughts and prayers, you too. ((((HUGS))))

Keely-FutureRN · Jun 17, 2005

breastfeedingRN said:

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.

I thought they couldn't judge the person or rank them for how they got liver problems whether it's through alcohol, overdose, genetics, or anything. I know kids get a priority but I thought it was about who needed it the most.

My thoughts and prayers are with you. I would get a flight over there. She needs support and love the most right now and I think she would really appreciate you being there for her and showing her that people care about her and love her. (hugs)

Keely

Mystery5 · Jun 17, 2005

Keely-FutureRN said:

I thought they couldn't judge the person or rank them for how they got liver problems whether it's through alcohol, overdose, genetics, or anything. I know kids get a priority but I thought it was about who needed it the most.
My thoughts and prayers are with you. I would get a flight over there. She needs support and love the most right now and I think she would really appreciate you being there for her and showing her that people care about her and love her. (hugs)

Keely

I've heard that factors that could lead to non-compliance, and thus ruin the donated organ, are strongly considered. So, they expect those who destroyed their liver through substance abuse to have successfully dealt with their addictions. I don't know regarding mental health issues such as this.

pricklypear · Jun 17, 2005

Factors like alcohol don't figure into the actual ranking - that is strictly by acuity. But it does figure into getting on the list. I don't know about a tylenol situation, though.

Teachchildren123 · Jun 17, 2005

I really feel for you, your family and your sister.

Try, try to go see your sis!

She needs you and family support now...then she will need psych-tx once stabilized. She needs to get rid of her pain by learning to cope a different way. Her suffering is spiritual. Deep, deep, deep.

This is a cry for help. The suicide did not go through, thank the Lord! Take care of her.

I hope that her hubby is supportive and understanding.

I have worked in the ICU for 3 years and all the Tylenol OD have recovered well, may your sister be well soon.

As for the ICU situation. Normally, no phone for any reason will be allowed. Everything has to be to promote her recovery. Nobody would want to disturb, she is very frail now, and beside, I am sure that she feels terrible about what happened and all. Guilt, fear, pain, sad all theses things she is going through, Bless her soul.

I have to admit also that some nurses do not know how to act with familly no matter what situation it would be. Sorry if they don't support you. We are.

I deeply feel for you all and pray for a recovery.

Keep us informed, please.

breastfeedingRN · Jun 17, 2005

Thanks again everyone. My sister is doing better today. GI doc saw her and was more optimistic than her doctor there at the hospital. He told her there is approx an 80% chance she will recover with a functioning liver and 20% that she will need a liver transplant. He said they still have to wait for another 1-3 days to see what will happen. She is still getting the Mucomyst thru the NG because she started with nausea and some vomiting again. They were giving her Phenergan today, so she was really tired, plus she hadn't been able to sleep until today and so she got some sleep.

I only spoke with her for a minute today and told her I love her. Spoke a couple times with my BIL and he says that she doesn't want me to come there because she knows we can't afford it and that he thinks it will make her feel worse if I do go visit. He said she knows how much I have been worrying and calling and she knows how much I love her. I think since if she keeps doing better, I will wait to go see her till she is out of ICU and possibly when I can stick around a bit to help her out.

We were both sexually abused as children and she has had a much harder time with it. She also has a history of bipolar disease and anxiety. She has never really gotten help for her issues and apparently she has had a lot of stress at home and work and it was just too much for her.

I am just praying she doesn't need a liver transplant. I am not sure how much history plays into effect and though I can understand why, it still is very sad when it is your family member.

Thanks again for all the encouragement. I am continually amazed at the kindness of complete strangers, but I should have figured I would get that from other nurses. I have some people I have known for years who haven't even emailed me back. Thanks.

onehusbandsevenkids · Jun 17, 2005

We were in the ED for 10 hours. She took 30 Tylenol Pm and 2 Loritabs. Was sick all night long. Didn't tell anyone until two days later. On day 5 after ingestion, she told me and we looked up tylenol toxcitity and she got scared. She called poicon control, they told her to immediately go to the ED, that they were calling ED to expect her and how long until she would arrive.

She was examined, blood taken, IV fluids given. Started the NAC IV about an hour or so after we arrived. Within 5 mins she started to react. Very flushed, itchy, eyes feeling dried out, tongue swelling. I get nurse (for some reason there are no call buttons anywhere in the ED???) Nurse comes in, turns off NAC, says she's going to have the Dr come in. We wait. Friend's reaction getting much worse, hives all over, out of her mind itchiness, face, neck and body swelling, tongue swelling even more and getting jagged looking bumps on the sides of it. All of this happened very quickly. I run to find the nurse, can't find anyone but cleaning staff (in a large city ED). Finally find nurse, she freaks....shoots 3 syringes of epinephrine into her, oxygen, leads, ect...move her out to in front of their station window.

She finally stabilizes. She gets moved into another ED room. We sit there for 3 hours and no one comes in for anything (well excpet for cleaning people) the nurses and docs pass us in the room constantly, no one comes in.

Finally psych doc comes and talks to friend for a while. Convinces her to check in for a few days to the local psych hospital.

If I'm dying, I do not want to be taken to this hospital's ED!!!!

An ED doc comes in later and says that they feel there would be no long term damage to he liver and she is free to go. She's discharged to immediately be driven to be admitted to the psych hospital where she is now.

So, I'm wondering...she took 30 - 500mgs each with 25mgs benedryl each....everyone here is talking about how dangerous it is and the ED says she is fine, no damage? Hmmmm..... What these docs said and what the docs from the OP's sisters situation don't really seem to jive....

But what do I know, I'm just a nursing student!

To the OP: I'm very sorry this has happened. I think you should do whatever you can to support and be there for your sister.

nicuRN2007 · Jun 17, 2005

breastfeedingRN said:

Thanks again everyone. My sister is doing better today. GI doc saw her and was more optimistic than her doctor there at the hospital. He told her there is approx an 80% chance she will recover with a functioning liver and 20% that she will need a liver transplant. He said they still have to wait for another 1-3 days to see what will happen. She is still getting the Mucomyst thru the NG because she started with nausea and some vomiting again. They were giving her Phenergan today, so she was really tired, plus she hadn't been able to sleep until today and so she got some sleep.
I only spoke with her for a minute today and told her I love her. Spoke a couple times with my BIL and he says that she doesn't want me to come there because she knows we can't afford it and that he thinks it will make her feel worse if I do go visit. He said she knows how much I have been worrying and calling and she knows how much I love her. I think since if she keeps doing better, I will wait to go see her till she is out of ICU and possibly when I can stick around a bit to help her out.

We were both sexually abused as children and she has had a much harder time with it. She also has a history of bipolar disease and anxiety. She has never really gotten help for her issues and apparently she has had a lot of stress at home and work and it was just too much for her.

I am just praying she doesn't need a liver transplant. I am not sure how much history plays into effect and though I can understand why, it still is very sad when it is your family member.

Thanks again for all the encouragement. I am continually amazed at the kindness of complete strangers, but I should have figured I would get that from other nurses. I have some people I have known for years who haven't even emailed me back. Thanks.

I am so sorry for what your family is going through. I am glad to hear that your sister is doing better though. I will pray for you guys.