The recommended dose of regular acetaminophen for adults and children 12 years of age or older is up to 650 milligrams every four to six hours. The extended-release form of acetaminophen should be swallowed whole, not chewed. Both the extended-release and arthritis formula tablets have an outer layer that dissolves immediately, then the remaining medication dissolves slowly allowing pain relief for up to eight hours. It is available in liquid and chewable forms, and in tablets. Alcohol (ethanol) and other substances or drugs can increase the production of NAPQI thus increasing the possibility of hepatic injury.Īcetaminophen can be purchased in regular strength, extra strength, extended-release form, arthritis formula and in several pediatric strengths. Malnutrition, chronic alcoholism, age and diet can lower the body's glutatione stores. In addition to NAPQI using up the stores of glutatione in the body, other factors can affect the amount of glutatione available. The NAPQI which is not detoxified can then bond to the lipid bilayer of hepatocytes causing them to become necrotic. In an acetaminophen overdose the stores of glutathione are used up and NAPQI is not detoxified.
The drug N-acetylcysteine (NAC) or acetylcysteine, commonly known by the brand name Mucomyst™, is quickly metabolized into glutathione once it enters the body. Consuming foods rich in sulphur-containing amino acids, such as asparagus, garlic and avocado, can help increase liver glutathione levels. Glutathione, which is manufactured inside the cell, is often called the body's master detoxifier. Most of the remaining acetaminophen binds to glutathione and is then excreted as nontoxic mercapturate conjugates. The liver metabolizes approximately 90 percent of the absorbed acetaminophen dose into water soluble sulfate and glucuronide conjugates.2 These conjugates are then removed from the blood stream by the kidneys and eliminated from the body. Although acetaminophen itself is nontoxic to the liver, the metabolite NAPQI can destroy liver cells (hepatocytes). When acetaminophen is taken into the body, the liver metabolizes it into the chemical N -acetyl-benzoquinoneimine (NAPQI). When you eat, the liver absorbs and stores fat, sugars, vitamins and other nutrients that you have consumed. The liver accomplishes many important functions such as storing glycogen, regulating blood glucose, plasma protein synthesis, hormone production, removing waste products from your blood and breaking down (metabolizing) and eliminating toxins. In the United States, attempted suicide accounts for more than two thirds of acetaminophen-related liver injuries, whereas accidental overdoses account for only one third of the cases.1 Although acetaminophen is exceptionally safe when taken in therapeutic doses, liver damage can occur by taking more than the recommended dose or when taken with other substances such as alcohol. The brand name Tylenol™ is derived from it's chemical name N -acetyl-p -aminophenol. Acetaminophen is available under the brand name Tylenol™ and other trade or generic names. An analgesic-antipyretic, acetaminophen is available as a single drug or in combination with other common prescription and over-the-counter medications such as Lortab™, Anacin™ and Midol™. In this article you will learn about acetaminophen and how it can damage the liver, tests performed when there is an acetaminophen overdose, treatments commonly used in an acetaminophen overdose and the supportive care of an acetaminophen overdose patient.Īlso known by its chemical name, N -acetyl-p -aminophenol or APAP, acetaminophen became an over-the-counter medication in the 1950's. Upon arrival in the Emergency Department, approximately three hours after her overdose, Amanda was immediately started on treatments to help prevent liver damage that could lead to her death. About two hours after taking the medication Amanda got scared and informed her mother of what she had done. Sixteen-year-old Amanda had an argument with her mother and tried to commit suicide by taking a Amouthful of acetaminophen. You have just received the report on an overdose patient who will be coming from the Emergency Department to your floor. Powell, RN, MSN, Ph.D.Īcetaminophen death emergency department end of life liver injury overdose suicide
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