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Dr J Burk
Dr J Burk, Doctor (MD)
Category: Health
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Experience:  MBBS MRCGP
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I just realized that I''ve taken 5,200 mg of Acetaminophen

Customer Question

I just realized that I''ve taken 5,200 mg of Acetaminophen in the past 24 hours. Have I overdosed? I am 47 years old, 210 lbs, and I do not drink alcohol at all.
Submitted: 9 years ago.
Category: Health
Expert:  Nurse Annie replied 9 years ago.

This is an overdose and I would make a trip to the ER as this can damage the liver. Symptoms may include nausea, vomiting, diarrhea, abdominal pain, sweating, seizures, confusion, and an irregular heartbeat. So please do make a trip to the ER to be evaluated.
Customer: replied 9 years ago.
Reply to Nurse Annie's Post: There seems to be a lot of contradictory information from health professionals about this topic. I spoke with a pharmacist, and he said that at that daily dosage, (5,200 mg) an adult would have to consume it every day for months for there to be an overdose, and subsequent permanent liver damage. And here it is 40 hours after this alleged "overdose" took place, and I have yet to experience any symptoms, and I am still fine. I haven't gone to the ER nor to any doctor about this, so I cannot help to conclude that I will be ok, and that this in fact was NOT an overdose. However, I do not plan to repeat this practice.

I've read somewhere that for children, 4,000 mg per day is the absolute safe maximum dosage. So if 4,000 mg of Acetaminophen within a 24 hour period is a maximum for children to avoid liver damage, then why in the world wouldn't I avoid liver damage after taking 5,200 mg since I am an adult and weigh in at 210lbs?

Furthermore, if my liver was permanently damaged from that dosage, wouldn't I have had signs of jaundice by now (yellow eyes, yellow skin)? I realize that any signs of jaundice would indicate that it would be too late for any anecdote, but I've only exceeded the maximum daily dosage for children by 1,200 mg.
Expert:  Nurse Annie replied 9 years ago.

In the medical literature for this medication, it states that for adults, up to 1000 mg is fine every 4-6 hours, and not to exceed 4000 mg in 24 hours. Hence, anything over this amount is considered an overdose as such this is why I advised you to get checked out, just to be safe, and moreso if you were experiencing any symptoms. That you have no symptoms, quite possibly means that no damage was done, but I would still mention this to your doctor the next time you see him/her for an evaluation.
Customer: replied 9 years ago.
Reply to Nurse Annie's Post: Annie, thanks very much for your help. I don't mean to sound ungrateful for your concern. The 4,000mg limit for 24 hours for this drug seems to be the printed maximum in various sources. However, if that info is accurate, then I just don't understand why the pharmacist I spoke to disregaurds those guidelines. Furhtermore, I also don't understand why the overdose threshhold would be the same for everyone.

For instance, why wouldn't a 210lbs man such as myself avoid overdosage and liver damage from a 5,200mg dose spread out over a 24 hour period, if according to the printed sources, a woman of say 110lbs would be fine with 4,000mg over that same 24 hour period, as well as even a 55lb child be okay after that 4,000mg daily dosage? Every other piece of literature I've ever read from the drug manufactures for other drugs clearly indicated that dosages are dependent on body weight of the individual(s) in question.

So why shouldn't the overdosage threshold also be dependent on body weight? Furthermore, if one dosage/overdosage threshold is being printed in the journals and/or the drug manufactures' literatures for patients of all bodyweights and ages, then I would think that the amount that was decided upon by the sources and thereby printed in the journals and literatures, has a built in safety cushion and is on the conservative side for the sake of children, as well as for adults who merely weigh in at 110lbs (which is NOT uncommon for adult women).

I'm quite sure that the sources of such info are no doubt very aware that they have a certain degree of legal responsibility of what they print concerning drug dosages and maximum limits, as I'm sure they're also aware that there are Attorneys around every corner just waiting for an opportunity to commence litigation from such potential cases.

So again, I do appreciate your input. I just think that perhaps there needs to be a balance between justified alrms, or warnings, and unneccesary panic.
Expert:  Nurse Annie replied 9 years ago.

I completely understand where you are coming from. Everyone however does metabolize medications at a different rate, so what could be safe for one person, may not be for another but guidelines need to be put on all medications, and usually it is just a standard.
Customer: replied 9 years ago.
Reply to Nurse Annie's Post: ok Annie. One more thing that I want to take shot at here, however, I'm not sure if you're going to be able to address this next question or not, but here it goes:

according to my studies, when someone is omitted in the ER with possible Acetaminophen overdosage, first a Liver function blood test is done (although I'm not sure on that, but that isn't the focus of my question anyway, so please read on). Then a substance refered to as "NAC" ( N-Acetyl-Cysteine ) is administered to the patient, which I believe is a precursor to the amino acid L-Glutathione.

This "NAC" (N-Acetyl-Cysteine) as I'm sure you know, is the anecdote to Acetaminophen overdosage, which if administerd to the patient within 12-16 hours after the overdosage took place, will prevent permanent liver damge from the overdose.

This "NAC" substance is likely better known to people in your profession as "Mucomyst" since that is atleast one of the brand names, and it is administered via I.V. (or perhaps the nasal route, I'm not sure on that).

But here's my question- My assumption is, that the only reason that this "NAC" is not administered via the oral route, is likely because most overdose patients are suffering naseua and/or vomiting anyway,(which is a common symptom of Acetominophen overdosage) and the substance would likely induce vomiting if it were given the oral route.So I believe that this is why the "NAC" in "Mucomyst" is used rather than using "NAC" in pill or tablet form.

Furthermore, I'm also aware of the fact that the procedure in these events is to pump the stomach of the patient in order to evacuate any possible Acetaminophen left in the gut, which might cause further overdose, and subsequently increasing the possibility of permanent liver damage.

But what if someone at home, who is NOT feeling nasea, but like myself, was/is concerned that they have accidentally ingested an overdosage of Acetaminophen? Would the administration of "NAC" via oral route with pills that I have found in a healthfood store, serve to act as an anecdote, and to prevent permanent liver damge just like the "NAC" in the "Mucomyst" product does when it's used at the ER, if the person in question is NOT suffering any nausea, and can tolerate an oral dosages of "NAC" ( N-Acetyl-Cysteine )?? And if so, can you tell me what the dosage would be? I assume that the pills would need to be taken every 2 hours if that would work via the oral route, and the "NAC" pills are usually 600mg each.
Expert:  Dr J Burk replied 9 years ago.
You have recieved the correct advice.

One of my own patients had a liver transplant last year because he accidentaly took too may acetaminophen for a cold.

By delaying your visit to the ER you put yourself at greater risk.

There is no way of knowing if you are in danger without a blood test.

Dr Jef
Expert:  Nurse Annie replied 9 years ago.

It would not be a good idea to self medicate and treat an overdose at home, whether you are feeling symptoms or not. So I would steer clear of taking anything from a healthfood store.
Customer: replied 9 years ago.
Reply to Nurse Annie's Post: Thanks for your reply, but since you mentioned one of your patients who had liver damage, I must ask you, what dosage did your patient take, and you also didn't answer my question concerning the "NAC" pills. Why am I getting the impression that this issue is a "hot potato"??? Can't you supply me with details rather than merely a generic answer? I mean no sarcasm nor disrespect to you by my choice of words, so please don't take offense.
Expert:  Nurse Annie replied 9 years ago.

This was not me that had stated about having a patient- this was a different expert. I have however taken care of many in patient overdoses including Tylenol over the years but these were suicide attempts so not related to your situation. No healthcare professional would ever recommend self treatment for an overdose so this is why I would not recommend picking up something from a healthfood store that is not FDA approved.
Customer: replied 9 years ago.
Reply to Nurse Annie's Post: Yes Annie, I know that it wasn't you. My reply was for "Dr. Jef"....

anyway, it's about 55 hours since I took this dosage, and I still feel fine, and am w/out symptoms. I would think that if I had liver problems from this mistaked dosage ingestion that were permanent, then it would've showed by now. I was mainly inquiring about this in an attempt to determine if I had a narrow window of time to get to the ER in order to have the anecdote administered.

But I believe that it's already past the time for any anecdote, and as I've stated, I feel fine. It was "Dr. Jef" who mentioned one of his patients who overdosed, that I was asking what that dosage was, because something tells me that it was much more than the dosage that I took.
Expert:  Dr J Burk replied 9 years ago.

I agree entirely with what you have been told.

Treatment for an overdose is with IV medication - the notion of a "do it yourself" remedy is not one that I can endorse in any way.

My patient had taken 6000mg.

Dr Jef

Customer: replied 9 years ago.
Reply to Dr J Burk's Post: Once again, you reply as if there's an Attorney by your side at all times, dictating your every word. I can see thst I'm not going to get anything extra from you. Nevertheless, Here it is 3 days after this alleged "overdose" and I am still w/out any symptoms at all. If there was permanaent liver damage then certainly there would be symptoms.

A phamacist I know says that there are many people he knows who are his customers, who take 5500-6000mg daily for years, and have not experienced liver problems. He doesn't recommend that anyone do that, but he assures me that doing so for merely one day won't damage the liver in an adult. But I'm sure that for legal damage control you'll come back to argue with that, lest you be considered liable in any way for your words in this forum. So much for this service. What was I thinking? I'm done here.

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