Patient education: Acetaminophen poisoning (The Basics)

What is acetaminophen poisoning? — Acetaminophen poisoning is when a person takes too much of a medicine called acetaminophen (sample brand name: Tylenol). This medicine is used to relieve pain. It is called "paracetamol" outside of the US. Acetaminophen poisoning can cause serious, long-lasting problems. It can even lead to death.

People often take too much acetaminophen, either by accident or on purpose. Taking too much medicine is also called an "overdose." Accidental overdoses sometimes happen because many non-prescription medicines have acetaminophen in them. When people take 2 or more of these medicines, they might not realize that they are taking more acetaminophen than is safe. Children can also get access to acetaminophen and take too much.

What are the symptoms of acetaminophen poisoning? — Some people have no symptoms after an overdose. In people who do have symptoms, the symptoms change depending on how long it has been since the overdose.

In the first 24 hours after an overdose, symptoms can include:

●Nausea and vomiting

●Sweating

●Paleness

●Feeling tired and sick

On days 2 and 3, the symptoms from the first day often go away. But that does not mean that the person is better. During this time, the liver or kidneys can stop working normally. Symptoms can include:

●Belly pain

●Not urinating as much as normal

After day 3, the symptoms from the first day can come back. The person might also:

●Become confused

●Develop jaundice – This is when the skin and the whites of the eyes turn yellow.

If the poisoning was very bad, the person could die during this stage.

Is there a test for acetaminophen poisoning? — Yes. The doctor or nurse can order a blood test to check the level of acetaminophen in the blood. They will probably also order blood tests to check how the liver and kidneys are working. That's because acetaminophen poisoning can damage these organs.

Should I see a doctor or nurse? — If you think you or your child took too much acetaminophen, call the Poison Control Center. In the US, the phone number is 1-800-222-1222. See a doctor or nurse, or go to the emergency department, if the Poison Control Center tells you to.

If possible, be prepared to tell the doctor or nurse:

●Exactly which medicines you or your child took

●How much of each medicine was taken

●When the medicine was taken

Bring the medicines with you, if you can. This way, the doctor or nurse can look at all of the ingredients.

How is acetaminophen poisoning treated? — Treatments can include:

●N-acetylcysteine, also called "NAC" – NAC is a medicine that can keep acetaminophen from harming the body. It is an "antidote." It works best if it is given soon after an overdose (within 8 hours).

●Activated charcoal – This is a medicine that attaches to any acetaminophen that is still in the stomach or intestines. This keeps the body from absorbing it.

●Liver transplant – This is when a doctor replaces a person's damaged liver with a healthy one. People who have too much liver damage as a result of acetaminophen poisoning sometimes need a new liver.

Can acetaminophen poisoning be prevented? — Yes. To prevent acetaminophen poisoning:

●Never take more medicine than the label says.

●Never take 2 medicines that both contain acetaminophen at the same time. You can check if acetaminophen is 1 of the ingredients by looking at the medicine label (figure 1).

●Never leave any medicine where a child could reach it.

●When giving acetaminophen to a child, follow the instructions on the label. Use the dosing cup or syringe that came with the bottle. If you are not sure how much you should give, ask your pharmacist, nurse, or doctor.

●If you have liver disease, ask your doctor before taking any medicines that have acetaminophen in them.

In some cases, people take too much acetaminophen on purpose.

Get help right away if you are thinking of hurting or killing yourself! — Sometimes, people with depression think of hurting or killing themselves. If you ever feel like you might hurt yourself, help is available:

●In the US, contact the 988 Suicide & Crisis Lifeline:

•To speak to someone, call or text 988.

•To talk to someone online, go to www.988lifeline.org/chat.

●Call your doctor or nurse and tell them that it is an emergency.

●Call for an ambulance (in the US and Canada, call 9-1-1).

●Go to the emergency department at your local hospital.

If you think someone might have depression, or if you are worried that they might hurt themselves, get them help right away.

More on this topic

Patient education: Taking medicines when you're older (The Basics)
Patient education: Giving your child over-the-counter medicines (The Basics)
Patient education: Acetaminophen dosing in children (The Basics)
Patient education: Taking medicines during pregnancy (The Basics)
Patient education: Drug-induced hepatitis (The Basics)