Acetaminophen Overdose: Therapeutic Analysis

Opioid abuse has become so widespread in Baltimore that on March 1, 2017, the governor of Maryland, Larry Hogan, declared a state of emergency. The rise in the number of opioid-related overdoses in the Baltimore have skyrocketed in the past few years. According to the Maryland Department of Health and Mental Hygiene, 1089 people, a majority from Baltimore, died of a fentanyl overdose in 2015. In 2016, the number rose to 1856 deaths. (Maryland Department of Health and Mental Hygiene 14). The spike in overdose deaths can be contributed to the increased use of Fentanyl. Fentanyl is 50 times more potent and costs less than a third of heroin (Adwanikar; Duncan). Drug dealers mix fentanyl with heroin to make their product less expensive to produce

More than 28,000 families a year get the terrifying call that their loved one has overdosed. Majority of the time police officers are the first to arrive at the scene of an overdose, accident, or crime. Some law enforcement officers are equipped with the lifesaving opioid antidote, Narcan, however, not all law enforcement in America carries the drug. Currently, over 1000 police departments carry the drug but, still that is not enough.

Rates of opioid-related overdose have been rapidly increasing in the United States. From 2010-2015, overdose deaths attributed to the use of illicit opioids has increased by over 200% (1). In 2016, the number of opioid-related deaths reached 64,070, the highest number ever recorded in the nation’s history and anticipated to increase (2). While opioid-related overdose had been largely caused by prescription opioid misuse, the problem is increasingly due to heroin and other illicit opioid use (3, 4). Increasingly, illicitly-manufactured fentanyl (IMF), an opioid much stronger than heroin, has become an increasingly common additive pervasive in the supply in the United States and has contributed to the steep rise in opioid-related overdose (5-8).

(Reid, 2015) Adverse effects of acetaminophen are hepatotoxicity, liver damage and/or death, and renal failure, kidney failure. Acetaminophen has been linked to Stevens-johnson Syndrome, toxic epidermal necrolysis, and acute generalized exanthematous pustulosis, several potentially fatal skin reactions. Consequently, clients receiving acetaminophen should be closely monitored for “skin rashes and flu-like symptoms (Byrd, 6). Acetaminophen, however, is easier on the GI tract than other pain medications and does not have antiplatelet effects, anti-blood clotting. Acetaminophen treats mild to moderate pain and fever. However, acetaminophen does not treat inflammation and in a recent trial, physical function or stiffness did not improve in clients. (Reid, 2015) If chronic pain is accompanied by inflammation or stiffness then NSAIDs or salicylic acid (ASA) may be used

As a widely used analgesic and antipyretic agent, acetaminophen (APAP) overdose induced hepatotoxicity is one of the most common causes of acute liver failure in the USA and in most Western European countries [1]. Although a number of studies have forced on the influences of N-acetyl-p-benzoquinone imine (NAPQI), a highly reactive metabolite of APAP that depletes hepatic glutathione, and increases in oxidative stress during APAP toxicity [2], other mechanisms such as immune response also raise the susceptibility in the early stages of APAP-induced liver injury [3]. Accumulating evidence demonstrates a critical role of inflammatory cytokine released in early liver damage after APAP intoxication [4, 5]. Kupffer cells (KCs), the liver resident macrophages, are major sources of reactive oxygen species (ROS) and inflammatory

On the 18th November 2014, a 34 year old woman was admitted to Daisy Hill Hospital (DHH) in a hepatic encephalopathic state. She was referred by her GP with symptoms of nausea, vomiting, dyspnoea, weakness, a reduced urine output, PR bleeding and central and peripheral oedema. These symptoms began in July 2012 and have been ongoing to date. Medical records indicated that in May that year she had undergone a partial gastrectomy to treat a non-healing gastric ulcer. The patient also had a background history of excessive use of Non-Steroid Anti-Inflammatory Drugs (NSAIDs), which was suspected to have caused the gastric ulcer in May. Liver function and routine blood tests were requested with a serum drug overdose screen.

(Fruchter, Alexopoulou, & Lau, 2011). Acetaminophen, commonly known under its name-brand: Tylenol©, can cause for drug-induced acute interstitial nephritis (AIN) when it is combined with other drugs, such as alcohol. (Fruchter, Alexopoulou, & Lau, 2011). However, within the past few decades, there have been very few reports of drug-induced acute interstitial nephritis (AIN). (Fruchter, Alexopoulou, & Lau, 2011). Drug-induced acute interstitial nephritis (AIN) is usually caused by the ingestion of two or more drugs. (Fruchter, Alexopoulou, & Lau, 2011). There are two main drugs that are commonly associated with drug-induced acute interstitial nephritis (AIN): antimicrobials and nonsteroidal anti-inflammatory drugs (NSAIDs). (Fruchter, Alexopoulou, & Lau, 2011). However, the number of drugs that are associated with drug-induced acute interstitial nephritis (AIN) keep rising annually. (Fruchter, Alexopoulou, & Lau, 2011). Fruchter, Alexopoulou, and Lau (2011) states, “Drug-induced acute interstitial nephritis (AIN) represents a common cause of renal injury in today’s medical practice.”(p.1). The quote shows that renal(kidney) injury has been one of the main problems that results from drug-induced acute

Acetaminophen, once ingested into the body is rapidly absorbed from the gastrointestinal tract into the blood stream where it reaches peak plasma concentration in as little as half an hour. Here, it circulates around the body for a period of up to 4 hours during which it produces its analgesic and antipyretic effects before the acetaminophen is metabolised and deactivated by the liver by a possible 3 pathways: Glucuronidation, sulfation and oxidation (Show below in Figure 2). The most commonly used pathway is the glucuronidation metabolism, closely followed by the sulfation pathway. These methods of metabolism deactivate the acetaminophen in the hepatocytes into non-toxic conjugated sulphate and glucuronide which are excreted in the urine [23] [24]. The majority of the initially ingested therapeutic dosage is metabolised this way, with the remaining acetaminophen being metabolised via the third hepatic cytochrome P45 oxidase pathway, primarily by the enzyme CYP2E1 [25]. When acetaminophen is metabolised via this method, a small amount of a highly reactive toxic intermediate

It is expected to see a high number of medication errors occurring in the Emergency Departments considering the fact that EDs are usually overcrowded and have an increased patient volume, which may create interruptions and increased pressure in the workplace that may lead to medication errors. However, it was very surprising to find out that the most prevalent medication error types in the ED were drug omission and wrong dose/overdose. It was shocking to learn that one of the predominant classes of drugs involved with these types of medication errors was antibiotic class since antibiotics are the most commonly used medications. The medication error related to patient’s weight was the most impressionable on me. I feel that patient’s weight is one of the easy obtainable information and at the same time one of the most important information since many drugs are dosed based on patient’s weight. I think every hospital should have a standardized procedure that would require a healthcare professional to obtain an actual patient’s weight no matter what department the patient is in because this information may be very helpful to identify an appropriate therapy as well as to prevent a medication error from occurring.

Acetaminophen (also known as Paracetamol) is an acylated aromatic amide and is an analgesic drug used as in many cold and flu medications [1]. At At therapeutic doses, Acetaminophen is metabolized to to paracetamol glucuronide and paracetamol sulfate, and are then excreted in the urine [10]. A minor component of APAP is also oxidized by the microsomal cytochrome P450 system, predominantly by Cyp2E1 and Cyp1A2 [11], to form a reactive metabolite, N-acetyl-p-benzoquinone imine (NAPQI) [12]. This minor metabolite is typically harmless, since it is mostly conjugated with glutathione and excreted in bile [13,

This article by The Washington Post reports on 7 year old girl who had been trying to wake her parents for more than a day. When she couldn’t wake her parents she took it upon herself to get dressed on Monday morning and went to school. On the bus ride home she told the driver she’d been unable to wake the adults in her house. After arriving at the scene authorities found the bodies of Christopher Dilly, 26, and Jessica Lally, 25, dead of suspected drug overdoses. Also inside the home were three other children. This case is part of an epidemic of drug overdoses and their impact on families around the Allegheny area. There were 422 opioid overdose deaths in Allegheny County last year the largest death toll in the county’s history (Citation).

During 2014, a total of 47,055 drug overdose deaths occurred in the United States, showing a 1-year increase of 6.5 per cent, from 13.8 per 100,000 people in 2013 to 14.7 per 100,000 people in 2014. People do not realize that one hundred people each day die from a drug overdose. Overdosing is now the leading cause of accidental death in the United States, accounting for more deaths than traffic fatalities or gun homicides and suicides. People believe that if they’re sick if they take certain types of drugs and they will get better, but all it does is hide the symptom’s until they become too sick to ignore the facts.

DOI: 1/4/1999. The patient is a 66-year-old male delivery person who reports bilateral wrist and pain, right greater than left, from continuous twisting of nozzles. As per OMNI, the patient was initially diagnosed with lumbar spinal stenosis, bilateral carpal tunnel syndrome, upper extremity tendinitis, depression, gastritis and sleep disorder.

Drugs can kill by the impact of far-reaching addiction. Impact of far-reaching addiction can be very fatal. Far-reaching addiction could cause cardiovascular disease, stroke, cancer, lung disease, and many mental disorders. Although impacts of far-reaching addiction are very serious, combinations of different drugs are usually more fatal. Combinations such as alcohol and heroin or painkillers are are fatal and common combination. That combination is deadly because all three of those substances suppress breathing in a different way. Painkillers and alcohols suppress breathing and heroin increases it. This will cause the excitatory, breathing out, and inhibitory, breathing in, to be out of balance. Stimulants such as heroin, cocaine, and methamphetamine can kill in a various amount of ways. They can kill by overheating, brain damage, and heart attack. Smoking can also kill. Smoking can kill by lung cancer or a nicotine overdose which will paralyze breathing muscles causing a failure in breathing. Drugs can kill in many different

If the patient came to the hospital unconscious (collapsed or is not breathing) due to drug overdose then would perform CPR. If the patient swallowed pills but is not showing any symptoms yet, it is not advised to try to make the person vomit or give them anything to eat or drink. To treat the overdose the patient's stomach may be pumped and activated charcoal may be given orally (it absorbs the drug that caused the overdose).