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Acetaminophen Overdose

Overview

Acetaminophen is a term used for paracetamol in some countries like Hongkong, US, etc while paracetamol is used in other countries. Paracetamol is derived from coal tar. It is active metabolite of phenacetin which is a carcinogenic. Acetaminophen is an extremely safe drug but it may cause harmful effects when it is taken in large doses. It is found in variety of pain relievers. This can cause a fatal liver damage.
Paracetamol works as analgesic (painkiller), anti pyretic and anti-inflammatory drug. It has potent action as pain killer and as anti-pyretic but is not so effective as anti-inflammatory. It is a COX inhibitor. COX(cyclooxygenase) are the group of enzymes which are necesary for the conversion of archidinoic acid into prostaglandins H2. This prostaglandin is further converted into prostaglandins like PGE2, PGF2, etc; these prostaglandins are responsible for inflammation and causing pain. Paracetamol inhibits the cyclooxygenase enzyme and thus it helps in lowering the hypothalamic set point in the  thermoregulatory centre. 


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Causes

The acute median dose of Acetaminophen to cause harm to the liver is about 24g. About 200 milloion people takes acetaminophen, out of which 200 peoplie die due to paracetamol poisoning. Maximum dose for adult is 4g. Some of the pain medications that contain acetaminophen include hydrocodone with acetaminophen (Lortab, Vicodin), tramadol with acetaminophen (Ultracet), propoxyphene (Darvocet), oxycodone (Percocet, Tylox), pamabrom, pyrilamine (Midol, Pamprin), and Tylenol with codeine. Acetaminophen was also shown to increase the risk of major cardiovascular events (nonfatal myocardial infarction, fatal congestive heart failure, nonfatal and fatal stroke). 


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Signs & Symptoms

Symptoms may not occur until 12 or more hours after the acetaminophen is swallowed. The following signs may appear:

  • Abdominal pain
  • Appetite loss
  • Coma
  • Convulsions
  • Diarrhea
  • Irritability
  • Jaundice
  • Nausea
  • Sweating
  • Upset stomach
  • Vomiting

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Prevention

The following preventions can be taken:

  • Always Keep the acetaminophen out of reach of children in closed containers and in child proof bottles.
     
  • Never mix two tablets both having acetaminophen in their ingredients.
     
  • Take it always in recommended doses.
     
  • Do not take acetaminophen if you consume more than 3 alcoholic beverages per day.

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Treatments
Activated Charcoal Naturopathy

Activated charcoal can be given in any drug poisoning, as the charcoal can bind the remaining drug in the stomach with itself, reducing its effect.

Antidote and Laxatives Modern Medicine

An antidote is a substance which nullifies the effect of poison. Here the antidote for acetaminophen overdose is N-acetyl cysteine. The medication has a foul odour but may be mixed with juice or other flavorings to make it taste better. 
Laxatives can also be given to clear the stomach.  

Stomach Washing Modern Medicine

Stomach washing is a technique where the stomach is emptied by inducing vomiting or it may be washed by inserting tube in the stomach. 
 

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