Notes from an emergency room doctor: "How
many did you take?" I asked, holding up the
empty bottle of Tylenol. She did not answer, lying
on the gurney like a limp ragdoll with her eyes
closed. I pinched her and reluctantly she opened
her eyes to gaze vacantly at whoever was disturbing
her reverie. "How many did you take?"
I asked again. She stared at me, still silent.
"Boyfriend problem," the paramedic
that brought her in volunteered. "She told
him she took the whole bottle."
Boyfriend problems, marital problems, family
problems, money problems - all can stretch an
individual's ability to cope. For some the pain
is intolerable and the simple solution seems to
be to ingest a bottle of anything handy in the
medicine cabinet - acetaminophen (Tylenol), aspirin,
"I just wanted to sleep," a patient
will tell me. Or, "I needed something to
make the headache go away." Certainly, there
are those with concrete plans to kill themselves,
but most people who take these remedies have no
suicidal intent. They're merely looking for a
brief respite from their pain or crying out for
Ironically, overdosing on these usually benign
over-the-counter analgesics can be more seriously
life-threatening than most prescription medication
overdoses. They're certainly more common.
A Tylenol overdose is perhaps the most serious.
In therapeutic doses, Tylenol is usually a very
safe drug. But in excess, it is a potent liver
toxin. Taking 15 grams or just about 30 extra-strength
Tylenol tablets at once can result in death. About
one to four hours after ingestion, patients may
complain of severe abdominal pain, or they may
feel faint or dizzy, or some may have no symptoms
at all. The true severity of the problem does
not become apparent until two or three days later
when liver failure develops. By the eighth to
tenth day after ingestion, an overdose patient
may suffer a horrible death.
The liver stores an enzyme that converts acetaminophen
into a harmless substance. This enzyme becomes
depleted with excessive drug ingestion. It is
also depleted in alcoholics, among those who are
fasting, or those who are malnourished or have
wasting diseases. Tylenol can therefore be toxic
even in normal doses in such susceptible people.
For instance, an alcoholic taking Tylenol regularly
for a week and not eating can be at very high
risk. Studies show that 20-25% of alcoholic patients
with acetaminophen toxicity die.
There is an antidote to acetaminophen overdose.
It's called N-acetylcysteine or Mucomyst. But
it is only effective if given in the early hours
Although aspirin and ibuprofen can also cause
liver injury, the most significant danger with
these drugs is gastrointestinal bleeding.
The most effective early intervention for almost
any overdose, including those of over-the-counter
analgesics, is to administer activated charcoal.
As long as the patient is fully conscious, and
unlikely to vomit and aspirate the charcoal solution,
it should be given. Charcoal can not only effectively
absorb drugs from the gastrointestinal tract but
can also clear them from the blood stream as well.
"Drink this," the nurse will say,
proffering a large cup containing the gritty black
activated charcoal solution. And no refusal will
be tolerated. "Drink this, please,"
the nurse will say one more time. If refused,
a tube the size of your pinky finger will be passed
into the patient's nose and down into their stomach.
Activated charcoal, and if necessary any antidotes,
will be passed through it. While patients generally
have the right to refuse therapy, no one has the
right to kill themselves.