Normally, NAPQI is detoxified by glutathione and is eliminated in the urine or bile. Metabolism of the drug results in formation of a small amount of the toxic metabolite N-acetyl-p-benzoquinone imine ( NAPQI). Recently, the FDA requested that manufacturers of acetaminophen-opioid products limit the acetaminophen content to 325 mg due to a concern that prescriptions such as Vicodin are a risk factor for acetaminophen-induced hepatotoxicity due to the increased likelihood of multiple supratherapeutic doses.Īcetaminophen is metabolized in the liver by conjugation with sulfate and glucuronide. In chronic overdose (i.e., multiple supratherapeutic doses), the minimum toxic threshold is 150 to 175 mg/kg over two to four days. In children less than 12, the minimum toxic dose for an acute ingestion ranges from 120 to 150 mg/kg. In many of these cases, patients took more than one acetaminophen-containing product but did not realize that acetaminophen was in more than one of the medications that they took. Nearly half of acetaminophen overdose cases were due to unintentional overdose. Repeated supratherapeutic doses can also cause hepatotoxicity. Types of exposures include exploratory ingestions in young children, intentional ingestions (e.g., teen suicide attempts), inappropriate therapeutic dosing, and iatrogenic IV overdose. Acetaminophen toxicity is one of the more common overdoses reported to poison centers and is the most common cause of acute liver failure in the United States. At recommended doses, it is considered safe and well tolerated.ĭespite this overall safety, acetaminophen is a dose-dependent hepatotoxin. Acetaminophen is available in a number of preparations including liquid formulation (160 mg / 5 ml), pills or capsules that range from 80 to 650 mg / tab, and immediate release suppositories. In addition, hydrocodone/acetaminophen was the most commonly dispensed medication in 2003 with 89 million prescriptions. It is found in more than 600 medications, including sleep aids and cough, cold, and allergy medicines. This can happen when an adult leaves the bottle open or within a child's reach after using medication.Acetaminophen, or Tylenol, is a commonly used antipyretic and analgesic and is the most common drug ingredient in the United States. Overdoses often occur when a child mistakes acetaminophen for something safe to eat or drink. Your child mistakes the medication for candy or juice.If you're not satisfied with the performance of the recommended dose of acetaminophen, you might increase the dose or its frequency and cause an accidental overdose. You might cause an overdose if you give your child adult acetaminophen instead of a children's formulation. Also, cough and cold medicines should be avoided in children younger than age 6 due to possibly serious side effects. If the remedy contains acetaminophen, this can result in a dangerously high dose.
If your child has various cold symptoms, your instinct might be to combine acetaminophen with an over-the-counter remedy. Or you may give two doses too close together if you don't realize that another caregiver has already given your child a dose. You might unknowingly give your child too much acetaminophen if you misread the instructions or if you don't carefully measure the medication. An acetaminophen overdose can happen in the blink of an eye.
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