May 29, 2023

Last week, I was starting my night shift and I had a male patient come in stating he had just taken 50 pills of 500 mg of Tylenol PM.

Hey guys caitlin here and for this week’s youtube video i wanted to talk about aspirin and tylenol overdoses so last week i was starting my night shift and i had a guy come in complaining that he had just taken 50 pills of 500 milligrams of tylenol pm and i was just like oh wow let’s get things started let’s get all the labs and since it was tylenol pm he had

A lot alike anticholinergic symptoms he was a little bit shaky his eyes were super wide dilated and he has a history of suicide never from tylenol but that was my first tylenol overdose so i thought this week we could talk about tylenol overdoses and i’ll throw in aspen overdoses since both of them are super similar so let’s get started so obviously with my

Patient he was an intentional overdose but you can also have accidental overdoses and this can occur with kids especially aspirin is in wintergreen oil so if you are pairing you’re adding this to children’s either their drinks for some joint relief or topically you can have aspen overdoses and also with kids towels right it looks like candy so they might write

It and then with adults you see a lot of tylenol overdoses with people who are on a long term pain medicine so a lot of percocet norco have tylenol in it but a patient’s usually don’t know this so they’re taking like 325 or tylenol with their hydrocodone and then they’re taking time little on top of that for additional pain relief which is fine but if you go

Over four grams a day for tylenol that is you know overdose toxicity levels so these patients can accidentally deal with a lot of chronic pain users so speaking of max doses per day tylenol you don’t want to go over four grams per day for adults and that’s the same for aspirin and adults no more than four grams per day the max dose for aspirin and children is a

Hundred milligrams per kilogram per day but typically you want to avoid aspirin and children because the possibility of rhea syndrome and the max dose for tylenol and children was 75 milligrams per kilogram per day in terms of clinical symptoms of overdose attalla and aspirin you’re gonna have a lot of the initial symptoms being the same between the two so both

Of them will present with nausea vomiting an increased respiratory rate arm labs they’re gonna be a little bit similar as well you’re gonna see metabolic acidosis between both of them you’re gonna see hypokalemia and then aspirin mainly affects the kidneys so you might see a little bit of an aka i increase creatinine and then tylenol it’s gonna cause a little

Bit of an increase lts especially on day 1 or 2 and on day 1 and 2 your patient may be complaining of right upper quadrant pain and if you have a child presenting with ray syndrome you’re gonna have nausea vomiting rash and increase l of t’s so just being look out for those two i know a lot of them a lot of the symptoms are similar but then kidney and a liver are

The differences between the two so just keep that in mind in terms of treatment we can start with aspirin there’s no specific antidote for aspirin it’s going to be a lot of resuscitative measures making sure the patient is maintaining a b and c you want to do a lot of iv fluids normal saline you’re not going to correct any metabolic derangements so that usually

Involves replacing potassium and then you can consider activated charcoal and hemodialysis and a lot of hemodialysis indicate really does severe cases so the clinical deterioration if you have severe metabolic derangement severe acid based arrangements if your patient has needed ventilator support if there is any aka eye or altered mental status that you don’t

Want to consider hemodialysis and then with tylenol overdoses it’s a lot of the same thing a lot of resuscitative measures maintaining abcs replacing potassium all these patients are gonna be fluid down you want to give them normal saline and then the addition of tylenol is the antidote of knack so you’re gonna want to do neck if your patient has a tylenol over

150 at four hours post ingestion and the dose is 150 milligrams so it’s like the rule of 150 well as they say with tylenol and then you can also do activated charcoal as needed so that is treatment and that’s it guys thanks for listening i hope you enjoyed this quick overview of aspirin tylenol overdoses again both look very similar upon initial presentation the

Treatments very similar except for the antidote of tylenol being neck keep in mind of all the metabolic derangements and the initial management of just being supportive measures and the silver resuscitation fluids and low potassium using that activated charcoal if it’s been within four hours and then knack at the four hour dose after tylenol has been taken is

Above 150 you’re gonna want to start neck at 150 milligrams per kilogram alrighty guys see you next week

Transcribed from video
Aspirin (ASA) & Acetaminophen (APAP) Overdose By Medgeeks