Dr. Lee was born in Shanghai, China, and received his college and medical training in the United States. He is fluent in English and three Chinese dialects. He graduated with chemistry departmental honors from Harvey Mudd College. He was appointed president of AOA society at UCLA School of Medicine. He underwent internal medicine residency and gastroenterology fellowship training at Cedars Sinai Medical Center.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
What should be done if acetaminophen toxicity is suspected?
A physician should evaluate the individual immediately. Remember that
bringing the bottles of acetaminophen and all of the person's other medications
to the emergency room is always useful. The risk that an acetaminophen overdose
will cause liver injury correlates with the blood level of acetaminophen
relative to the time the drug was taken. Physicians, therefore, are able to
estimate the patient's probability of developing liver injury after an overdose.
To make this determination, they obtain the patient's history of acetaminophen
ingestion and measure the blood level of the drug. With this information, the
doctor then can refer to a table (nomogram) that provides an estimate of the
risk of developing liver injury. The accuracy of this estimate, however, depends
on the reliability of the time of ingestion and whether the acetaminophen was
taken over a period of time or all at once.
With suspected
acetaminophen overdose, the doctors usually will pump (gavage) the patient's
stomach to remove pill fragments. In reality, many individuals who overdose with
acetaminophen in a suicide attempt will have taken other pills in addition. Some
doctors, therefore, will consider treating the patient with activated charcoal,
which binds (and thereby inactivates) many medications. However, this treatment
is controversial because of a concern that the activated charcoal may also bind
the antidote for acetaminophen overdose.
Patients who are
thought to be at a high-risk or even only at a possible risk of developing
acetaminophen liver injury should be given the antidote, N-acetyl cysteine
(Mucomyst) orally (or intravenously in Europe). This drug works by indirectly
replenishing glutathione. The glutathione, as you recall, detoxifies the toxic
metabolite of the acetaminophen. The N-acetyl cysteine is most effective when
administered within 12 to 16 hours after the acetaminophen was taken. Most
physicians however, will administer N-acetyl cysteine even if the patient is
first seen beyond this 16 hour period. Thus, a British study showed that
patients already with liver failure who then received the N-acetyl cysteine were
more likely to survive than patients who did not receive the antidote. Moreover,
the survival occurred in these patients regardless of the time of initial
administration of N-acetyl cysteine. Finally, people who recover from
acetaminophen-induced liver damage are left, fortunately, with no residual or
ongoing (chronic) liver disease.
Abdominal pain is pain in the belly and can be acute or chronic. Causes include inflammation, distention of an organ, and loss of the blood supply to an organ. Abdominal pain can reflect a major problem with one of the organs in the abdomen such as the appendix, gallbladder, large and small intestine, pancreas, liver, colon, duodenum, and spleen.
Liver disease can be cause by a variety of things including infection (hepatitis), diseases such as gallstones, high cholesterol or triglycerides, blood flow obstruction to the liver, and toxins (medications and chemicals). Symptoms of liver disease depends upon the cause; however, common symptoms may include nausea, vomiting, upper right abdominal pain, and jaundice. Treatment depends upon the cause of the liver disease.
Alcoholism is a disease that includes alcohol craving and continued drinking despite repeated alcohol-related problems, such as losing a job or getting into trouble with the law.
The liver is the largest solid organ in the body, and is actually an gland. The liver has a wide variety of critical functions such as manufacturing proteins and metabolizing fats and carbohydrates. The liver also eliminates harmful biochemical waste products from the body (alcohol, drugs, toxins). The liver secretes bile that aids in digestion. Examples of diseases of the liver include cirrhosis, hepatitis, cancer, and fatty liver. Symptoms of liver disease include bleeding, easy bruising, edema, fatigue, and jaundice.
Coma is the inability to waken or react to the surrounding environment. The Glasgow Coma Scale is frequently used to measure the depth of coma. Causes of coma include trauma, bleeding, edema, lack of oxygen, poisoning, or hypoglycemia. Prognosis for a patient in a coma depends on the cause of the coma.
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