Tylenol toxicity? How serious?? Please read!

akcarmean, LPN · Jun 17, 2005

breastfeedingRN said:

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.

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 you and your family is going through. My BF about a year ago had a tylenol OD but hers was accident. She was taking ST. John's Wort OTC and Tylenol for severe pain. (Turns out she had MS and no one had DX it yet) but as it turns out St. John's Wort contains tylenol so with the combination she had to much build up in her system. At that time she also had a hepititis virus so her liver wasn't working correctly in the first place. Thank God she is still here we have been BF for 24 yrs. actually more like sisters than BF. I can say I understand everything you are feeling. B/c before her MS was DX. she tried suicide several more times.

I can also understand the sexual abuse been there also. I also have OCD, Manic Depression, Anxiety along with some other health issues.

If you go at all wait until she gets home. That is where you will be needed and can help the most. I know how hard it is but I will add your family to my prayers.

You can turn her anytime you need to. There are a lot of us who have a lot of knowledge and can be great support system for you. Then there are also a lot of us who have been through similar things and can understand from that view point also.

Suicide scares people and it's like it has a curse with the word or something. At times when people don't understand things they stay away thinking that is better. I don't know. It is hard. I know when we lost our daughter that a lot of people stayed clear of us. Then there were some people who said things like "You can always have more children" and "This was God's doing and you need to live with that" just some stupid things that should not be said at a funeral. People like that I would have preferred if they just said sorry instead of saying anything at all but I know they had their hearts in the right place. (now I do know) anyways.

I hope she continues to do well and I will keep you and all of your family in my prayers. Please keep up updated.

Take care,

Angie

breastfeedingRN · Jun 17, 2005

onehusbandsevenkids said:

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.

From what I have read, everyone is different. Maybe she had a healthy liver and since it was so many days past, they probably could have seen how her liver was reacting and maybe that is why they let her go. I imagine they started the NAC before they checked her acetaminophen levels and her LFTs. By 5 days, you should probably know what effect the Tylenol had on her liver.

My sister takes Tylenol PM quite frequently to help her sleep, not sure why the Tylenol PM and not plain Benadryl, but I didn't know about that. She has been RXd sleeping pills but doesn't like how they make her feel in the morning. I wonder if that is why her liver is being a little stubborn, maybe it already wasn't really healthy.

Hope your friend is okay. I would have her follow up with her PCP to get liver studies done to make sure no damage was done. Good luck to her and hugs to you for having to go through that as well. Very scary.

onehusbandsevenkids · Jun 17, 2005

breastfeedingRN said:

From what I have read, everyone is different. Maybe she had a healthy liver and since it was so many days past, they probably could have seen how her liver was reacting and maybe that is why they let her go. I imagine they started the NAC before they checked her acetaminophen levels and her LFTs. By 5 days, you should probably know what effect the Tylenol had on her liver.
My sister takes Tylenol PM quite frequently to help her sleep, not sure why the Tylenol PM and not plain Benadryl, but I didn't know about that. She has been RXd sleeping pills but doesn't like how they make her feel in the morning. I wonder if that is why her liver is being a little stubborn, maybe it already wasn't really healthy.

Hope your friend is okay. I would have her follow up with her PCP to get liver studies done to make sure no damage was done. Good luck to her and hugs to you for having to go through that as well. Very scary.

Thanks for the suggestion of the PCP follow up for liver studies, this wasn't mentioned to her. The anaphlatic (spelling? sorry, I'm exhausted) shock was very scarey!

My friend is pretty overweight at about 250lbs, wonder if that has something to do with it? She did say that since she had done it, she had been feeling flu-like symptoms.

She has been diagnosed with mixed bi-polar (haven't heard of that one) and aggravated depression at the psych hospital. She was / is taking Wellbutrin and Effexor - now they've added Clonopin. She has a horribly dysfunctional family and was physically/emotionally/sexually abused during her childhood.

Complete chaos for a childhood.

Glad your sis is doing better, it sure sounded scarey for a while, huh?

Sending prayers out to your sister.

Mystery5 · 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.

Dear breastfeeding,

It's so sad, your story about your sister, and how much troubles she and you both have had in life! I really pray that God sends healing right away. Child abuse is so horrible. Sometimes this world is just too much and I can relate to your sister's despair! I hope she'll get a second chance, for the good of everyone involved!

breastfeedingRN · Jun 17, 2005

Mystery5 said:

Dear breastfeeding,
It's so sad, your story about your sister, and how much troubles she and you both have had in life! I really pray that God sends healing right away. Child abuse is so horrible. Sometimes this world is just too much and I can relate to your sister's despair! I hope she'll get a second chance, for the good of everyone involved!

I spoke to her nurse again this morning and they said she had a rough night last night and that she is sleeping right now. She had nausea and vomiting all night. Her LFTs were all up this morning, but the GI doctor told them that that is expected for up to 5 days. The docs and nurses there don't seem to think that it is okay, but the GI doctor does. She told me that she will probably be in the ICU for another few days, she isn't ready to be transferred to telemetry, which is what they were thinking she might be able to do.

Anyone else seen the LFTs and bilirubin keep getting worse for up to 5 days? Is this really possibly a normal course and she might be okay?

pricklypear · Jun 17, 2005

If the GI doc isn't worried, I wouldn't be, either. There are lots of other labs that continue to rise for a few days before resolving. Cardiac enzymes with MI, renal labs with acute insult, etc. I don't really know much about liver funtion tests, but I would think that the organ is shedding dead tissue and generally not funtioning up to par right now, it's putting a lot of energy into repair/recovery, so seeing some continued elevation would be expected. I have noticed that liver enzymes are usually the last to resolve in patients with short term multi-organ problems.

noki74 · Jun 17, 2005

Hi! Im very happy that your sister is getting better but even you have to wait anouther 5 day concerning a biluribin checking it may be ok so maybe no need to made a liver transpaltion everything depend how strong imunity she have, but hoope that everything will be ok keep a faith don't loss a hoppe

All the best

rjflyn, ASN, RN · Jun 18, 2005

I am going to make a comment re the ranking of these pts ( Tylenol OD) for transplant since some other posters have mentioned it. This is based on what I know from one hospital ( level 1 univeristy setting).

Most generally they need an emergeny liver transplant ie their liver function is totally gone as upposed to alot of others than need a liver ie hep c, alcoholic hepatitis ect - they still have minimal function. A person who has taken a tylenol OD either kills their liver or they dont its either going to recover or it wont hench the need for a transplant. Most other liver damage is chronic where the OD pts is acute and large ie all at once. The liver is one amazing organ by its ability to repair its self up to a point, but if you hurt it to much it cant. Thats what a tylenol OD does- it hits it so hard it actually kills the liver so fast it cant keep up.

Now to comment on the original posters situation, she mentioned a hospital that I havent heard of. I know a few nurses from that area and none of them have ever made mention of it. The did comment about the other hospital there as being a real good one. Good to see that an actual GI specialist is involved. As far as going to telemetry most of these pt in my exp dont, they dont have cardiac problems to monitor so typically are transfered to the psych unit. I do see it as a good sign that she is still in the original hospital- unless they do liver transplants- as if they thought that the likelyhood of a transplant was high she would have been transferred to a facility that does them by now, Or she should be.

RJ

breastfeedingRN · Jun 18, 2005

rjflyn said:

I am going to make a comment re the ranking of these pts ( Tylenol OD) for transplant since some other posters have mentioned it. This is based on what I know from one hospital ( level 1 univeristy setting).
Most generally they need an emergeny liver transplant ie their liver function is totally gone as upposed to alot of others than need a liver ie hep c, alcoholic hepatitis ect - they still have minimal function. A person who has taken a tylenol OD either kills their liver or they don't its either going to recover or it won't hench the need for a transplant. Most other liver damage is chronic where the OD pts is acute and large ie all at once. The liver is one amazing organ by its ability to repair its self up to a point, but if you hurt it to much it cant. Thats what a tylenol OD does- it hits it so hard it actually kills the liver so fast it cant keep up.

Now to comment on the original posters situation, she mentioned a hospital that I havent heard of. I know a few nurses from that area and none of them have ever made mention of it. The did comment about the other hospital there as being a real good one. Good to see that an actual GI specialist is involved. As far as going to telemetry most of these pt in my exp don't, they don't have cardiac problems to monitor so typically are transfered to the psych unit. I do see it as a good sign that she is still in the original hospital- unless they do liver transplants- as if they thought that the likelyhood of a transplant was high she would have been transferred to a facility that does them by now, Or she should be.

RJ

rjflyn,

thanks for the info. I don't think she is in the best hospital in her area, but my BIL feels comfortable there I think. it was the closest hospital to their house.

one of the nurses did mention that if she needed a transplant she would probably go to a different hospital because they don't do transplants there. I think she said she would go to university of alabama hospital because they do them there.

I guess in my heart I know that if she needs a transplant, she won't get one and will likely die. that sucks. I know they haven't started testing or even blood typing so maybe that is a good sign, maybe it is just because they know she won't actually get one if she needs one. I have AB- blood and don't know what she has.

I keep praying she was in the 10 hour window with starting the treatment. I know it doesn't guarantee she will live, but it is better than the stats after 10 hours.

breastfeedingRN · Jun 18, 2005

breastfeedingRN said:

rjflyn,
thanks for the info. I don't think she is in the best hospital in her area, but my BIL feels comfortable there I think. it was the closest hospital to their house.

one of the nurses did mention that if she needed a transplant she would probably go to a different hospital because they don't do transplants there. I think she said she would go to university of alabama hospital because they do them there.

I guess in my heart I know that if she needs a transplant, she won't get one and will likely die. that sucks. I know they haven't started testing or even blood typing so maybe that is a good sign, maybe it is just because they know she won't actually get one if she needs one. I have AB- blood and don't know what she has.

I keep praying she was in the 10 hour window with starting the treatment. I know it doesn't guarantee she will live, but it is better than the stats after 10 hours.

well, I talked to my BIL and he says that she is doing better today. her liver enzymes are going down and they are talking about transferring her to a med/surg floor and from there she will go to the inpatient psych clinic there for a mandatory 72 hours. she has already seen a psychiatrist there as well, today I think.

I have been trying to get in touch with her nurse, but she has been busy each time I have called. I hope to be able to talk to her soon.

akcarmean, LPN · Jun 19, 2005

Glad she is feeling better I will continue to keep all of you in my prayers.

Angie

breastfeedingRN · Jun 19, 2005

akcarmean said:

Glad she is feeling better I will continue to keep all of you in my prayers.
Angie

hi all. my sister is doing much better. she is going to med/surg floor today and I think she might be out of the hospital and into the psychiatric hospital by the next day. she is doing good and now comes the harder part, healing herself emotionally.

from the bottom of my heart, thanks to all those who took the time to respond to my post. it helped me so much to get my questions answered and helped me to have some hope she would get better. thanks!