I was reading another blog, GoTeamWood, that immediately caught my attention from my mom side and my professional side, a pediatric pharmacist. Please read it; mom Jen did a great job of describing what happened.
I will describe acetaminophen (Tylenol(R)) toxicity for everyone to explain, hopefully in laymen's terms, what the physicans at the ER where concerned about.
Acetaminophen Toxicity
Acetaminophen is a common medication used for the relief of pain or fever. It is not to be used for anti-inflammatory reasons. It is present in many over the counter (OTC) medications, which is why there has been cause in the past years to reduce all children medications to single ingredient only. Many children were being overdosed because parents were unaware of the duplication of many ingredients in products. This is why speaking to your pharmacist (who is readily available to most people at their pharmacies) before dosing your children can help in preventing this problem.
Acetaminophen is metabolized (broken down) in the liver. Normal half life depends on the age of the child: in neonates, averages to 7 hours; in infants, averages to 4 hours; and in children, averages to 3 hours.
While children are a seemingly decreased risk of acetaminophen toxicity because of their preceived increased metabolism and increased glutathione (involved in metabolism) stores, they are still at risk and need to be triaged and assessed accordingly. If you think your child overdosed, do not hesitate to take them to the ER.
Ingestion is the most common route for acetaminophen toxicity (meaning, it is taken by mouth, either in tablet or liquid form). However, acetaminophen can also be given rectally (up the butt, not a classy way to put it, but essentially what it means) and can contribute and/or cause toxicity.
Signs of acetaminophen toxicity are truly nonspecific: nausea, vomiting, liver toxicity, and kidney impairment.
There are four stages in the clinical course of acetaminophen toxicity:
1) Preclinical toxic effects;
2) Hepatic (liver) injury;
3) Hepatic (liver) failure;
4) Recovery and/or death.
These four stages, which can overlap, are impacted by amount ingested; duration of the ingestion (overdosed over a time); coingestion with other medications; presence of comorbidities; and timing of medical interventions.
So... your child took acetaminophen, and you suspect an overdose. Go to the ER. The ER will first take a serum acetaminophen level (to see how much acetaminophen is in the blood) and liver function tests (to see if the liver has been damaged). The level of acetaminophen is particularly effective if you know the time of the ingestion, so if you do, or suspect a time, make sure to tell the ER staff. When the level comes back, it will be plotted on a Rumack-Matthew nomogram. This nomogram helps to determine if your child is at low to moderate to high rish for toxicity. If it is low, your child will be monitored for a bit and then most likely discharged home without much fuss (which is what helped in the blog I mentioned earlier).
However, if its moderate to high, treatment options will be brought up. There are two main types: decontamination and antidotes. Decontamination usually works with a known ingestion time and if there is a coingestion. Gastric lavage (not a pretty sight), if done, is usually within 1 hour of ingtestion, but is generally not recommended. Activated charcoal, also not a pretty thing to see, is done usually within 2 hours of ingestion. Do NOT use ipecac or cathartics.
Antidote - in the case of acetaminophen toxicity is acetylcysteine - is the preferred method to go, even though there is a difference in opinion of dosing and time tables. However, it does work. Acetylcysteine works to help restore liver glutathione, serves as a glutathione substitute, and enhances nontoxic sulfate conjugation of acetaminophen (in other words, helps with metabolism of the acetaminophen).
I hope this helps a little to explain the process. I won't go much more into it, and always talk to your healthcare professional if you have questions, and never hesitate to go to the ER if you suspect your little one ingested something they shouldn't. Another tip: don't treat medication like candy, don't ever call it candy, and KEEP IT LOCKED! Child preventative caps are a joke. Do not believe they will prevent your child from opening a bottle.
*Written for informational purposes only*
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