Tylenol

Question 1

Tylenol OD

Tylenol Metabolization:

Answer 1

Acetaminophen→ NAPQI via P450 (toxic metabolite) → glutathione → non toxic metabolites

Question 2

Tylenol OD

Toxic Ingestion:

Answer 2

Toxic ingestion > 150 mg/kg (>7.5 g adult) - peak concentration 1 hour, complete 4 hours

Question 3

Tylenol OD

Hepatotoxic-

Answer 3

Zone III (centrilobular) → necrosis → fulminant liver failure

Question 4

Tylenol OD

Tylenol OD
Time Line:

Answer 4

1: 0-12 hrs- pre injury- n/v, anorexia- Increase Acetaminophen level
2: 8-36 hrs- liver injury- n/v, RUQ pain- transaminitis (AST first)
3: 2-4 days- max liver injury- liver failure, encephalopathy, coagulopathy- multiorgan failure, ARDS
4: > 4 days- recovery- none- complete hepatic recovery

Question 5

Tylenol OD

Tylenol OD
ASAP:

Answer 5

ABCs, IVs, O2, monitor, VS, acc ✓

Question 6

Tylenol OD

Hx:

Answer 6

Tylenol, opiates and OTCs (often contain APAP), acute vs chronic ingestion, SAMPLE hx

Question 7

Tylenol OD

Exam:

Answer 7

may be WNL

Question 8

Tylenol OD

Tylenol Labs:

Answer 8

APAP & LFTs (most important), also: ASA, EtOH, CBC, BUN/ Cr, lytes, gluc, coags, osmolality, VBG, UA, UDS, hCG; levels of any other known drug ingested, EKG

Question 9

Tylenol OD

Treatment cutoffs

Answer 9

See nomogram; treat if >7.5 gm (>140 mg/kg) APAP ingestion or if APAP >140 mg/dl at 4 h

Question 10

Tylenol OD

Treatment:
If pt can tolerate PO…

Answer 10

NAC 140 mg/kg via NGT
Then 70 mg/kg q 4hr up to 17 doses or till LFTs WNL and APAP level zero;
give w antiemetic

Question 11

Tylenol OD

IV Treatment:

Answer 11

If pt requires IV dosing…
Acetadote 150 mg/kg IV over 1 hr,
then 50 mg/kg over 4hr,
then 100 mg over 16h (in D5W)
Glutathione precursor and sulfur-containing glutathione substitute→ binds and decrease NAPQI formation
IV- more expensive, increase risk of anaphylactoid reaction, shorter duration