When Children and Medications Don't Mix

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*

Why didn’t you just go to medical school, at least you would have been a doctor.

UGH. If I ever hear that statement, or something similar, again, I just may scream. Why do I have to constantly defend my choice of a career path? Why isn’t being a pharmacist just as good as being a doctor? Let me tell you, I know more about your medications – and how they work – than your doctor (henceforth, a physician, because contrary to popular belief, I am a doctor, I have the degree to prove it!). I can’t tell you how many times I have prevented harm to patient because of that. I tell people, let your doctor diagnose you, but trust your pharmacist when it comes to medications (and always go to the SAME pharmacist you trust – it just may save your life!).


Let’s start at the beginning.

At work today, I worked the OR pharmacy. This means my daily interactions are with the anesthesiologists of the hospital, the PACU/Day Surgery nurses, the OR techs, physicians, and on occasion, even a surgeon (they are not magical beings people, just wanted to state that). I also see the patients on their way to surgery and after, entering their orders, checking for drug/drug and drug/allergy interactions, and providing the narcotics for each individual OR case. I work in a fishbowl, and I’m trapped in the small area which contains the OR pharmacy satellite. However, I like working here; I interact with more people than I answer phone calls (I will post about the day to day activities of an inpatient pharmacist in another post).

So, handing the narcotics over to the nurse anesthesiologist, she made a comment about the “new girl” that worked the day before. I informed her that was our most recent former resident, LP. “A resident? What does that mean in pharmacy?”

Um, the same as a medical resident, duh. Not – actually, a great deal – of graduating pharmacists do not undergo residency. It is a recent evolution in pharmacy for some pharmacists to undergo specialized training to become clinical staff, and one route is pediatric pharmacy (which I did, at the same hospital that I am gainfully employed with). After the first year, a small percentage of residents continue on to a second year (which was my original life plan, to go into pediatric critical care, but marriage and a pregnancy and the Navy derailed that plan at the moment). Either way, it is much like the medical resident. The pay is small but the rewards amazing.

So after I told her that I finished undergraduate school, then four years of pharmacy school, and a residency, she goes … “you might as well have gone to medical school after all that.”

Excuse me?! My choice isn’t as good as medical school? I don’t think so. It was almost a slap in the face. Yes, at one point, I wanted to go to medical school, but I LOVE pharmacy more. I like what I do on most days. I love the interactions (most of the time, there are some physicians who believe they know more than I do when it comes to medications and how they work and their place in therapy and…).

I really believe pharmacists need to speak up more. And not to be like physicians, but acknowledge our doctorate degrees (side note: not all pharmacists are doctors – but all the recent graduates are).

Yes, I am a doctor. Just not a physician… thank God!

Who am I?

It is still hard to believe, but next Friday, I turn 30.   The idea that I have been alive for three decades doesn't seem possible.  Where has the time gone?  Have I accomplished anything significant in thirty years?  Will I have time in the future to do all that I want to?

For accomplishments, by far the most important to me are my two little boys.  They are simply my everything.  They are the reasons I wake up in the morning, they give me hope.  Two little beacons of light.  How amazing it is to watch things through their eyes!  I love seeing Goober smile in wonder as he figures out something for himself... and Peanut? To see his eyes grow wide and smile when he sees me, or his brother, or his daddy.  He definitely knows we belong to him already at such a tender age of five months.

I finished pharmacy school, obtained my doctorate degree, completed my year of pediatric pharmacy residency, and still am working (though per diem, not full time).  I hope to eventually move into a clinical pharmacy position, but that will be when the boys are both in school full time.  Until then, I am a stay at home mom who works occasionally to make student loan payments!

My husband and I have dreams.  Dreams I hope to see to fruitation.  Until then, I am dreaming... and living a great life.

More to come...

Still trying to get a handle on this blogging thing...

So I am still trying to get a handle.  However, in my defense, I am also attempting to mother a very active two year old and his four - almost five - month old brother.  I'm trying to just stay afloat on the housekeeping, trying to start a "preschool" atmosphere for Goober, all while doing two week stints in Virginia working (because I am still a pharmacist... just some of the time).  Needless to say, this just hasn't been given priority...

That being said, I am going to try!  I really want to have something that documents Goober and Peanut as they grow up, to remember cute things they say, to show them off (I am a proud mama!).  We're doing cool things -- a summer bucket list currently that I got as an idea from two other blogs ... threetimesthegiggles and goteamwood -- and we have gotten quite a bit accomplish (next post, I will get more into that, once I get a copy of said list!).

For a quick update...

We're in Virginia (just got here Sunday, will leave on the 29th, my gasp... 30th birthday), Elijah is at home.  This weekend will be spent in Richmond with my sister Nicole, who is watching the boys on Friday (long story).  We will plan on taking them to the Children's Museum up there, which I haven't been to, and neither have the boys (maybe I will even post pictures -- oh my!).

Goober is so hyper, full of energy, interested in anything dinosaur, alligator, snake, water, and whatever you're cooking.  He loves to help, which of course just makes it take longer, but I love watching his curiousity.

Peanut is rolling over, rocking side to side, and loves to gab.  Goober and him will just have conversations, just the two of them, the adults just wishing we knew what they were conspiring (because you know they are, they are their father's sons).

Alright, off to do other things...

In the Beginning...

This is a trial, a sort of release for my thoughts, emotions, and battles with upcoming motherhood, being a pharmacist, and being a Navy wife in a new town. The targeted audience is mainly my family - which is a broad term to include those blood related, related through marriage, and the ones acquired over the years through friendship - but welcome to anyone who happens across this blog and is bothered enough to read it!

Briefly... I graduated in 2004 from Roanoke College with my Bachelor's of Science in Biochemistry and History (interesting combination, I know), and then went to Virginia Commonwealth University's Medical College of Virginia School of Pharmacy (a mouthful!). I graduated with my Doctorate of Pharmacy (Pharm.D.) in 2008. I completed a year of pediatric residency at the Children's Hospital of the King's Daughters in Norfolk, Virginia in June 2009. I worked at CHKD and at Walgreen's until my husband relocated us to South Carolina in September 2009. I remain per diem with the hospital and work shifts when I am in Virginia, and at Walgreen's as well.

Speaking of the husband (he's in he Navy)... we married in January 2009, and are about to celebrate our first anniversary. We are also expecting our first child in February 2010. Add to this our new home, and our four year old Black Lab mix Bacardi Razz, and there is a lot to handle! I love every moment of it.

I love my family. I have two younger sisters and a younger brother. Nicole is in the Army National Guard, and is currently activated. She works with an aviation unit. Her home is in Richmond, and she is the proud "parent" of two cats (Yuengling and Mojito) and a basset hound/blue healer mix dog, Southern Comfort (SoCo for short). Krystal graduated this past May 2009 from VCU's School of Nursing, and is working at Walgreen's as a pharmacy technician until she can find a nursing job. She also previously worked at CHKD as a NICU nurse's aid prior to graduating, and is the proud "parent" of a cat (Grey Goose) and golden retriever mix (Captain Morgan). Brother Keith is in the Navy, owns his own home, and has the only girl dog in our pack... a white mix of something named Skyy Berry. Throw in Remy Martin, my parents' mutt, and that is a few dogs that will be at my parents' for Christmas!

Well, I am going to go and finish some cleaning...