Suicide by Tylenol

What happens when you decide to take several hundred Tylenol in an attempt to kill yourself?  You think about that for a little bit.  Well, let me tell you.  Generally, you're going to end up dead or a very painful and excruciating terrible death or you are going to end up with a ruined liver needing a liver transplant on the transplant list and suffering and if you get a liver, well, you might live, but your life will never be normal again and if you don't get a liver you'll die like in the first scenario.  So faced with in this past emergency medicine shift I worked, a young individual and presented after swallowing several hundred Tylenol and he was found vomiting and next to the toilet by his family and there was an empty Tylenol bottle and they only can assume he took the whole thing.  It was a sad tragic case, so, what do we do.  Well, the first thing we do is when the patient gets there, we make sure the patient is stable and then back in the day they used to try to make the patient vomit.  They also used to try to do gastric lavage (pump the stomach) to flush your stomach. That's no longer the usual approach any longer. c 


There is an antidote to Tylenol poisoning, it's called N-Acetyl Cysteine. We make sure that the patient is currently stable, not losing their airway or seizing or in some other form of immediate life threatening catastrophe.  Usually, on presentation, they're just sick.  We assess their vital signs run some labs to test their liver function and measure their Tylenol level and we also do a tox screen to measure other drugs including aspirin, that they may have taken, we can start to gauge how real the Tylenol or acetaminophen overdose is.   N-Acetyl Cysteine basically  prevents the Tylenol from being metabolized into a toxin that kills your liver and so then you can get rid of the remaining Tylenol without metabolizing it into a poison.  Sometimes a person really does a job like this individual did, even with the greatest medical care and quick medical care, sometimes will not save the patient. Sometimes you can't beat the suicide attempt that the patient attempted and in this case unfortunately this patient had done such a number on himself and even with the antidote he died before our eyes and was successful in his suicide attempt.  




Suicide is never an easy case to manage and the sad part is dealing with the family after the fact and those that are left behind.  That's probably even harder than dealing with the patient themselves, so Tylenol is not the answer.