I have been fortunate enough to be asked to speak again at this year’s Mississippians for EMS (MEMS) conference in Biloxi. It is always a great time with highly-educational seminars for EMTs and paramedics alike.
If you recall, the last few years, I have worked as the director of the Cadaver Labs that were put on. This time, however, I am trading my scalpel for a slideshow and am honored to be one of the main speakers to the groups. Although the conference isn’t until next week, I thought I would give my readers a sneak peak of the focus of my seminar: Over-the-counter killers.
Virtually everyone has some sort of over the counter medications in their homes. They are so common that we often do not think of the dangers that they often pose to us.
“Sure, the bottle says take two pills, but your legs really hurt, so why not take four? It won’t hurt, right?”
Although it does depend on the medication, a great rule is to ALWAYS follow the dosing instructions on the medications that you take, prescription or OTC. Over the next few weeks, I plan to look deeper into the pain relievers, anti-inflammatories, and cold medications that are lurking above our bathroom sinks.
Tylenol is one of the most common pain relievers on the market. For those who never remember a time without Tylenol, it is an indispensable part of our lives.
Others might remember when it first came on the market (1955) and how it was hailed as a miracle cure. Don’t mistake me: I am not anti-Tylenol; I am anti-Tylenol overdose. The active drug in Tylenol is acetaminophen and a
typical dose is 325mg. Tylenol overdoses send around 22,000 Americans to the ER each year. Sometimes it is intentional (a common item many people have easy access to during suicidal actions) and sometimes it is unintentional (taking excessive amounts for an extended period). In either case, the result is the same: Liver damage that could possibly lead to an agonizing death.
Approximately 5 percent of the acetaminophen in a standard dose actually does what it is intended to do. The rest is vaporized before it reaches your liver. The nitty-gritty pathophysiology is that a specific cell group in your liver reacts to the medication (Cytochrome P450) and produces the desired effects. Increasing the dosage does not necessarily increase Tylenol’s effectiveness. Quite the opposite: more acetaminophen in your system means more than the average 5 percent is making it to the liver and the P450s become quickly overwhelmed.
A toxic dose of acetaminophen is considered somewhere around 100-150 mg per kilogram of body weight but because it is slowly metabolized out through the liver, it can build up rapidly and unbeknownst to the patient taking it over the course of several days. The main effects of an overdose will be felt over the next week.
It is often a slow, agonizing process marked by abdominal pain, jaundice, and possible death due to liver failure and sepsis. Medications used to treat this type overdose include Mucomyst (it stinks) and Acedadote (it’s expensive).
The best advice is to be smart and read the labels on the bottles. Never think that taking “extra” medication will have an “extra” effect of reducing pain. In many cases, you are only damaging your body.
Pay attention to 24-hour maximum doses and any other medications that might contain acetaminophen. Stay safe out there.
M. Eric Williams, MS, NR-P is a syndicated columnist and the Assistant Director of Emergency Medical Education at Jones County Junior College. He is a current Doctoral Researcher at Delta State University and has 15 years’ experience in Emergency Medicine.
