(off-topic) Toxic effects of Tylenol

[Guest guest]

When acetaminophen use becomes toxic. Treating acute accidental and

intentional overdose.

Salgia AD, Kosnik SD. Postgrad Med 1999;105:81-84,87,90.

Whether accidental or intentional, acetaminophen poisoning is not uncommon;

in fact, it is the most common drug-induced cause of liver failure. When

hepatic glutathione is depleted, the toxic metabolite NAPQI fails to be

conjugated and causes hepatic injury. At risk are chronic alcoholics, binge

drinkers, patients taking medications that induce the P-450 isoenzyme system,

and those with concomitant liver disease. The four phases that make up the

clinical course of acetaminophen poisoning distinguish signs, symptoms, and

laboratory values according to severity. In diagnosing acetaminophen

toxicity, adequate history taking and serial measurements of acetaminophen

level are essential. Treatment is rooted in three goals: decreasing the

absorption of acetaminophen using activated charcoal, replacing hepatic

glutathione using acetylcysteine, and supportive care in the case of hepatic

failure. The prognosis depends on the amount ingested and the time of

presentation after ingestion.