Article 1- Signs and Symptoms of Acetaminophen-Related Liver Damage

Acetaminophen overdoses can happen for a variety of reasons. If the overdose was accidental, it could have been caused by taking a combination of over-the-counter drugs that contain acetaminophen. When paired with prescription drugs and alcohol, the probability of overdosing on acetaminophen is much higher. If a person drinks an average three alcoholic beverages every day, doctors recommend that they do not take painkillers with acetaminophen, but to instead use ibuprofen (like Advil or Motrin) or aspirin. Most overdoses happen when the patient consumes an extremely high dose one time, but repeatedly ingesting slightly more acetaminophen than recommended can also result in an overdose.

There are four phases of an acetaminophen overdose that last over several days.

The first phase occurs within the first 12 - 24 hours. The patient will suffer from one or more of the following: nausea, vomiting, sweating, loss of appetite, diarrhea, and irritability. Not all patients display early symptoms of overdose. During this phase if a patient seeks treatment they will be given charcoal that will bind to the acetaminophen in the stomach. Then doctors will pump the stomach, aiming to remove all of the acetaminophen. Likewise they might give the patient N-acetylcysteine, or NAC, which is an antidote for acetaminophen overdose and can be taken orally.

The following 12 - 24 hours is called the latent phase. The patient will feel fine and all symptoms will completely disappear. Some patients may experience less frequent urination. Although it seems the body is doing fine, it is during this phase that the liver damage begins.

The third phase can begin between 48 and 72 hours after acetaminophen consumption. The first sign that the liver is damaged is typically a pain in the upper-right abdominal area or tenderness near the liver. The liver will be swollen. Following this, liver failure can occur. Signs of liver failure are jaundice (yellow eyes and skin), dark urine, confusion, hypoglycemia (low blood sugar), bleeding, nausea, and vomiting. During this stage liver blood test abnormalities will show up on blood tests. It is common for this type of injury to see extremely high levels of AST and ALT on liver blood tests. At this point the prognosis of lasting effects of the liver injury will be fairly accurate based on the exam and blood tests. Many patients who reach the third stage need a liver transplant in order to live. For some patients once the liver has been severely damaged, they also experience kidney failure and heart problems. Death may occur due to brain swelling, infections or, most commonly, multiple organ failure.

The fourth phase is 5-14 days after consumption of acetaminophen. This stage can last up to 21 days and patients either recover completely or die from liver failure. A full internal recovery can take up to 3 months.

If you experience any of these signs or side effects, you should contact a doctor immediately.

Possible signs of an overdose of acetaminophen:

Nausea Vomiting Loss of appetite

Sweating Extreme tiredness Unusual bleeding or bruising

Pain in the upper right part of the stomach Yellowing of the skin or eyes

Flu-like symptoms

Possible side effects of acetaminophen, regardless of dosage size:

Rash Hives Itching

Swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs

Hoarseness Difficulty breathing or swallowing

http://www.tylenolliverdamages.com/signs-and-symptoms-of-acetaminophen-related-liver-damage.php

ARTICLE 1 QUESTIONS:1) True or False: If a person takes a little more acetaminophen (brand name: Tylenol) than they should on a regular basis, it is still dangerous.2) What increases the probability of overdosing on acetaminophen?3) If a person is identified as overdosing, what does the doctor give them first and why?4) What organ is damaged by an overdose of acetaminophen?5) What are the signs of liver failure?6) If a person doesn’t die from liver failure due to acetaminophen overdose, how long does a full internal recovery take?7) Since all medicines have side effects, what are four possible side effects that are NOT due to overdose?

Article 2- Did you know ibuprofen can cause kidney damage? Posted by Dr. Claire McCarthy  January 28, 2013 08:00 AM

One of the most common medications parents in my practice give is ibuprofen. Known also by its brand names Advil and Motrin, it does a great job of bringing down high fevers and can be really helpful with pain, too. It's so helpful, in fact, that it's easy to think of it as completely safe.

It's not.

Now, no medication is completely safe. All medications can have side effects, and any medication can possibly cause an allergic reaction. And since acetaminophen (the other medication parents give for fever and pain) can cause serious liver damage if too much is given, it's easy to think that ibuprofen is the safer choice. 

But there is a difference between "safer" and "safe". That's what a study just out in the Journal of Pediatrics reminds us of. Researchers from Riley Hospital for Children in Indianapolis looked at medical records of children admitted to the hospital, and found that of those who had kidney damage, a significant number had been taking non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen (Aleve). Some of the kidney damage was serious.

This isn't news to doctors; we've known that along with possible bleeding problems, NSAIDs can damage kidneys. But we think of it as rare and we don't always mention it to parents. Which is our bad. But since medications like ibuprofen and naproxen are readily available without a prescription, we don't always get a chance to talk with parents about it either.

So here's what you need to know: while it's not common, NSAIDs can hurt the kidneys. It's more likely to happen when there is dehydration, as this concentrates the medication in the blood and the kidneys are already a bit stressed out dealing with the dehydration. 

What this means in practical terms:

Think twice before giving your child any over-the-counter medication. This is a good general rule of thumb. Ask yourself: is this really necessary?

Don't freak out over fevers. Fever is one of the ways the body fights infection, as germs don't like high temperatures. If your child has a fever but is basically comfortable and drinking, leave the fever alone. You'll avoid the risk of side effects from medication--and your child might even get better faster.

Don't give ibuprofen or other medications "just in case," to prevent a fever. I actually see this often; parents give it when their child has a cold, whether or not there actually is a fever. This is rarely a good plan--better to save the medication for when your child really needs it.

The other reason that parents give these medicines is for pain. While I am certainly not saying that you should let your child be in pain, if the pain is mild it's always good to think about other remedies, like massage or rest, and only give medications if they don't work.

Since dehydration can make NSAIDs more dangerous, don't give them if your child isn't drinking well. If they are drinking fine and you give them, make sure they keep up with the fluids.

If ever you're thinking about giving an over-the-counter medication and you aren't sure if it's a good idea, call your doctor. That's what we are here for!

At your next visit with your doctor, talk about over-the-counter medications such as ibuprofen. Get their opinion on which you should give, how much and when--and talk with them about what circumstances warrant a call. As I've said lots of times in other blogs, medicine works best when parents and doctors work as a team--it's the best way to keep children safe and healthy.

http://www.boston.com/lifestyle/health/mdmama/2013/01/did_you_know_ibuprofen_can_cause_kidney_damage.html

ARTICLE 2 QUESTIONS:1) What are the brand names associated with ibuprofen?

2) Why do people take ibuprofen?

3) What is an NSAID?

4) What organ can be damaged by NSAIDs?

5) What increases the chances of organ damage when taking NSAIDs, such as ibuprofen and naproxen (Aleve)?

6) When would you not give a child ibuprofen when they have a fever?

(go to next page for Q#7-8)

7) Looking at the dosage chart below, how much more concentrated is Concentrated Motrin vs. Children’s Motrin?

(Hint: you will need to do some math to convert the listed concentration to # of mg per 1 mL for each.)

8a) If you are 12 years old or over, what is considered 1 dose (use chart below)?8b) If you took the medicine at noon, when can you take more if necessary?8c) What is the maximum number of pills you can take in 24 hours?