Tuesday, October 27, 2009

Acetaminophen Overdose

I'm sure you've heard of acetaminophen. It's the primary ingredient in Tylenol. Did you know it's also found in: Actifed, Alka-Seltzer Plus, Benadryl, Butalbital, Co-Gesic, Contac, Darvocet, Excedrin, Fioricet, Lortab, Midrin, Norco, Percocet, Robitussin, Sedapap, Sinutab, Sudafed, TheraFlu, Unisom With Pain, Vick's Nyquil and DayQuil, Vicodin, Wygesic, and Zydone.

On Thursday, my 27-year-old cousin was taken to an emergency room via ambulance. Her symptoms were nausea, jaundice and confusion. Her mother initially thought she had overdosed on pain killers. After running several tests, doctors found that she was in acute liver failure. She was transferred to Montefiore Hospital in the Bronx and was put on the liver transplant list.

{ my cousin and grandma at our wedding }

Her condition made her a priority as her other organs started failing shortly after her arrival at the first hospital. Unlike renal failure or conditions relating to the heart, there is no machine that can keep you alive if your liver fails.

By Friday she was given 72 hours to live. They drilled a hole in her head to help relieve the swelling and pressure in her brain. She was wrapped in ice packs and a catheter was inserted into her groin to help cool her organs and give her more time. They induced her into a coma to help keep her vital organs stable.

By Saturday all of her organs were failing and she was rapidly deteriorating. They found a liver, but it wasn't a perfect match. The liver had scar tissue on it and it was a bit too large for her tiny frame. But without the liver she would definitely die. They gave her a 50% chance of surviving the surgery. When she went into surgery we were told she only had 3 hours left to live.

The surgery lasted 7 hours and at 3:45 Sunday morning we were told she made it through the surgery. By the end of the surgery she was so swollen that they had to leave her abdominal cavity open until her body could heal more. They plan to close up her stomach sometime this week. Today they will start to remove some of the medications she has been on which will help her drift back out of the coma.

The next step is running tests to see if there is permanent brain damage from the swelling in her brain, which was caused by her liver failure. We won't know the outcome of those tests for days. But she is alive. Against all the odds, she is alive.

The recommended daily dose of acetaminophen is no more than 4 grams in a 24 hour period. But what we're not told is that the acetaminophen can build up in your liver over time because it takes days for your body to metabolize drugs. This can create a synergistic effect which can enable an accidental overdose.

So, to clarify, if you take 4 grams of acetaminophen on Monday and 4 grams again on Wednesday, there are still trace amounts from Monday in your system on Wednesday. Makes sense, right? 8 grams of acetaminophen or the equivalent to 16 Tylenol is enough to cause an overdose in a 120-pound adult. And this is assuming you only took Tylenol. What happens if you mix Tylenol with Sudafed or NyQuil? A person taking the maximum daily dose of both Tylenol and NyQuil could end up accidentally ingesting 8 grams of acetaminophen -- double the current FDA recommendation -- a potentially toxic dose.

I had never heard of such a disease. And we literally watched her go from a bit naseous to her death-bed in a matter of hours. My family is not very faithful, but for 4 days they walked from the Synagogue to the Church and back again. And somehow our prayers were answered.

{ the whole fam-damly at the wedding }

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