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Group 3 Answers - Acetaminophen

Group 3 provided answers to questions asked by Group 5 about a case study involving acetaminophen (Tylenol) overdose. [1] Acetaminophen overdose can cause life-threatening liver damage and failure. Clinical manifestations of toxicity include nausea, vomiting, and abdominal pain within 24-72 hours, potentially progressing to liver and multiple organ failure. [2] Liver enzymes AST and ALT are the most sensitive markers for injury. [3] Toxicity may also impact the heart by causing oxidative stress and myocardial necrosis, potentially leading to heart failure. [4] The standard treatment is oral or intravenous N-acetylcysteine administration, with activated charcoal recommended within 1 hour of ingestion

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41 views

Group 3 Answers - Acetaminophen

Group 3 provided answers to questions asked by Group 5 about a case study involving acetaminophen (Tylenol) overdose. [1] Acetaminophen overdose can cause life-threatening liver damage and failure. Clinical manifestations of toxicity include nausea, vomiting, and abdominal pain within 24-72 hours, potentially progressing to liver and multiple organ failure. [2] Liver enzymes AST and ALT are the most sensitive markers for injury. [3] Toxicity may also impact the heart by causing oxidative stress and myocardial necrosis, potentially leading to heart failure. [4] The standard treatment is oral or intravenous N-acetylcysteine administration, with activated charcoal recommended within 1 hour of ingestion

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GROUP 3 ANSWERS TO GROUP 5 PRESENTATION

1. In the case study, patient is admitted to the hospital because of acetaminophen (Tylenol)
overdose. Overdoses of acetaminophen can precipitate life-threatening abnormalities in which
organ? Explain.

Over many years, it has been used countless times by many people, and it has proven to be a safe
and effective medication. However, if taken in excess amounts (overdose, whether on purpose or by
accident), acetaminophen can cause life-threatening illness.

Acetaminophen in overdose can seriously damage the liver. If the damage is severe, a liver
transplant may be necessary in order to save someone’s life. Acetaminophen is primarily metabolized
by the liver. Too much acetaminophen can overwhelm the way the liver normally functions.

2. What are clinical manifestations of acetaminophen toxicity?

Stage Time of Post Description


Ingestion
1 0-24 hours Anorexia, nausea, vomiting
2 24-72 hours Right upper quadrant abdominal pain (common)
AST, ALT, and, if poisoning is severe, bilirubin and PT
(usually reported as the INR) sometimes elevated.

3 72-96 hours Vomiting and symptoms of liver failure


Peaking of AST, ALT, bilirubin, and INR
Sometimes renal failure and pancreatitis

4 More than 5 days Resolution of hepatotoxicity or progression to


multiple organ failure (sometimes fatal)

3. Which tests are the most sensitive marker of injury caused by acetaminophen poisoning?

a. INR

b. AST and ALT

c. Bun and Creatinine

d. Alkaline phosphatase

4. In the case study, Explain the impact of Acetaminophen toxicity on Heart.

Toxic effects of acetaminophen in overdose leading to myocardial necrosis may


contribute to heart failure. Furthermore, oxidative stress from acetaminophen overdose
may contribute to heart failure as well.
2

5. The standard treatment for acetaminophen overdose is administration of N-


acetylcysteine given orally or intravenously. When is the addition of activated charcoal
recommended?

As with any ingestion, assessing for other potential life-threatening co-ingestants is very
important. Administer activated charcoal (AC) if the patient has a stable mental and clinical
status, patent airway, and presents to the emergency department within 1 hour of ingestion.
3

References:

KhabazianZadeh, F., Kazemi, T., Nakhaee, S., Ng, P. C., & Mehrpour, O. (2019, December).
Acetaminophen poisoning-induced heart injury: A case-based review. Daru : journal of Faculty of
Pharmacy, Tehran University of Medical Sciences.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6895290/#:~:text=Toxic%20effects%20of%20ace
taminophen%20in,failure%20as%20well%20%5B38%5D

O’Malley, G. F., & O’Malley, R. (2023, June 21). Acetaminophen poisoning - injuries; poisoning. Merck
Manuals Professional Edition. https://www.merckmanuals.com/en-ca/professional/injuries-
poisoning/poisoning/acetaminophen-poisoning#v8343420

Susan E Farrell, M. (2023, June 14). Acetaminophen toxicity treatment & management. Approach
Considerations, Gastric Decontamination, Oral N-Acetylcysteine.
https://emedicine.medscape.com/article/820200-
treatment#:~:text=As%20with%20any%20ingestion%2C%20assessing,within%201%20hour%20of
%20ingestion

WebMD. (n.d.). Tylenol poisoning (acetometophen overdose). WebMD.


https://www.webmd.com/a-to-z-guides/tylenol-acetaminophen-poisoning

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