From the Guidelines
Tylenol (acetaminophen) overdose can cause severe and potentially fatal side effects, primarily liver damage, and immediate medical attention is crucial to prevent long-term morbidity and mortality. The side effects of a Tylenol overdose can be severe and potentially life-threatening, emphasizing the need for prompt treatment. Early symptoms of an overdose include:
- Nausea
- Vomiting
- Stomach pain
- Loss of appetite
- Fatigue These symptoms may appear within the first 24 hours after ingestion. As the overdose progresses, more serious signs develop, including:
- Pain in the upper right abdomen
- Yellowing of the skin and eyes (jaundice)
- Confusion
- Bleeding Severe cases can lead to liver failure, kidney damage, brain swelling, coma, and death, as noted in studies such as 1 and 1. The liver damage occurs because at high doses, acetaminophen produces a toxic metabolite that depletes glutathione, a substance that normally protects liver cells.
Treatment and Prevention
Treatment must begin quickly, ideally within 8 hours of ingestion, with the antidote N-acetylcysteine (NAC), as recommended by 1. Anyone suspecting an acetaminophen overdose should seek emergency medical attention immediately, even if they feel fine, as symptoms may be delayed while liver damage is occurring. The maximum safe daily dose for adults is 3,000-4,000 mg (typically 6-8 regular strength tablets) in 24 hours. It's also important to note that repeated supratherapeutic ingestions, which involve taking more than the recommended dose over a period of time, can lead to a worse prognosis, as discussed in 1.
Key Recommendations
- Administer NAC to patients with possible or probable risk for hepatotoxicity as determined by the Rumack-Matthew nomogram, as recommended by 1.
- Do not administer NAC to patients with no risk for hepatotoxicity as determined by the Rumack-Matthew nomogram.
- Seek emergency medical attention immediately if an acetaminophen overdose is suspected, as emphasized by the need for prompt treatment to prevent severe outcomes, as seen in 1.
From the Research
Side Effects of Tylenol Overdose
The side effects of a Tylenol overdose can be severe and potentially life-threatening. According to 2, patients who have ingested a toxic dose of acetaminophen may exhibit signs such as repeated vomiting, abdominal tenderness in the right upper quadrant, or mental status changes.
Symptoms and Treatment
- Patients who have ingested a toxic dose of acetaminophen may be at risk of serious hepatotoxicity, as stated in 3.
- The treatment for acetaminophen toxicity typically involves the administration of N-acetylcysteine (NAC) to prevent hepatotoxicity, as mentioned in 3.
- Activated charcoal can be considered if local poison center policies support its prehospital use, a toxic dose of acetaminophen has been taken, and fewer than 2 hours have elapsed since the ingestion, as stated in 2.
- Studies have shown that the use of activated charcoal in addition to NAC therapy may provide improved patient outcomes, as seen in 4 and 5.
Patient Outcomes
- Patients who receive both activated charcoal and NAC after an acute acetaminophen overdose may have improved outcomes, including reduced incidence of liver injury, as measured by elevated serum transaminases and prothrombin times, as stated in 4 and 5.
- The use of NAC plus activated charcoal has been shown to be more effective than NAC alone in enhancing acetaminophen elimination in overdosed patients, as seen in 6.
Important Considerations
- Patients with conditions that increase susceptibility to acetaminophen toxicity, such as alcoholism or isoniazid use, may require special consideration, as mentioned in 2.
- The dose of acetaminophen considered as a repeated supratherapeutic ingestion (RSTI) should be greater than 4 g or 100 mg/kg (whichever is less) per day in patients with these conditions, as stated in 2.