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EM Basic

Acetaminophen overdose

EM Basic

EM Basic LLC

Residency, Student, Medicine, Er, Em, Intern, Health & Fitness, Medical, Education, Emergency

4.6665 Ratings

🗓️ 24 June 2014

⏱️ 29 minutes

🧾️ Download transcript

Summary

Today's episode talks about the diagnosis and management of Acetaminophen overdose.  This is another addition to the EM Basic Project written by Andrea Sarchi.

We encounter acetaminophen overdose frequently in the ED and we need to be on the look out for this because patients can be completely asymptomatic.  If we don't catch it, acetaminophen overdose can result in liver failure requiring transplant or even death unless we interevene early.  This episode will review how to properly workup a patient with a known or suspected acetaminophen overdose, what tests to order, and how to decide who needs antidote therapy.

Transcript

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0:00.0

This is Steve Carroll, and you're listening to the InBASIDIP

0:03.3

podcast. Today we're going to be talking about acetaminifin overdose, aka Tylenol or

0:08.9

paracetamol. Acetamidifin, or APP, for short, is a component of hundreds of over-the-counter

0:15.2

and prescription medications used around the world, and it's the most frequently used

0:19.9

analgesic and empiric in the United States.

0:23.4

While Cinehammedifen is great for relieving pain, its effects can be deadly when taken in overdose.

0:29.1

It is one of the leading causes of hospital admission and fatalities from oral poisonings,

0:34.4

as well as the most common cause of acute liver failure in the U.S.

0:38.4

Therefore, there are many cases of synonym and toxicity that we must be ready to deal with.

0:43.8

This episode is another addition to the EM Basic Project, and was written by Andrea Sarci,

0:49.4

a fourth-year medical student, now intern in the Air Force, who is interested in emergency medicine.

0:54.7

He wrote this script with help from Dr. Michael Pasifaro, and he am attending affiliated with

0:59.9

the NYIT College of Osteopathic Medicine. As always, his podcast and as I represent the views of

1:04.7

the Prince Department of Defense, the U.S. Army of the Fort Hood Post Command. All right, so let's get

1:08.3

started. As with most po poisonings, the patient's presentation

1:11.8

and incitement of toxicity depends on how long ago it was ingested. If the ingested was less

1:18.2

than 24 hours ago, the patient may be asymptomatic and look perfectly normal when you walk in

1:23.8

the room, even though they've taken a toxic dose. Even though APAP reaches peak

1:28.8

plasma concentrations within an hour of ingestion, and is completely absorbed within four hours,

1:34.5

it often takes time to manifest clinical symptoms. In some cases, the patient will be vomiting

1:40.3

and look lethargic and pale. If the ingestion was 24 to 72 hours ago, there may be signs of hepatotoxicity.

1:48.2

This is what we're most worried about when a patient presents with an APAP OD.

...

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