Acetaminophen, or Tylenol, is one of the most commonly used medications in the world. It is widely taken as a nonsteroidal anti-inflammatory drug and as a fever reducer. But like any medications, Tylenol can have serious side effects, particularly if taken in large amounts. One of the common complications of Tylenol overdose is elevation of the liver enzymes.
Liver Enzymes
Liver enzymes are proteins within the liver's cells. According to the Mayo Clinic, an elevation of the liver enzymes in the bloodstream indicates damage or inflammation of those cells. The two most commonly measured liver enzymes are alanine transaminase, or ALT, and aspartate transaminase, or AST. ALT is more specifically related to liver damage, since AST can also be found in other tissues, like the heart and muscles. The Mayo Clinic also identifies acetaminophen, or Tylenol, as a cause of liver enzyme elevation.
Tylenol Overdose
The liver has an enzyme that detoxifies the body from excess Tylenol. When there is an acute large ingestion of Tylenol, that enzyme is depleted, which then makes the liver vulnerable to cellular damage and liver toxicity. According to the Merck Manual, acetaminophen toxicity can cause liver toxicity within one to three days after ingestion. Remember that acetaminophen is mixed into many over-the-counter cold preparations, so large ingestions of other medicines that contain Tylenol can also cause liver toxicity and elevation of the liver enzymes.
Symptoms
The initial symptoms of Tylenol overdose are mild and include nausea, vomiting and abdominal pain. As the liver damage progresses, usually 24 hours after ingestion, the liver enzymes become elevated. According to the Merck Manual, the elevation of liver enzymes peaks about 72 to 96 hours after ingestion. At this time, the person experiences signs of liver failure, including jaundice, a yellowing of the skin and the whites of the eyes; tremors; disorientation and confusion. Untreated, this can lead to multiple organ failure, coma and death.
Treatment
Prompt initiation of therapy is important to avoid complications of Tylenol toxicity, including liver failure. A chart, known as the Rumack-Matthew nomogram, can predict the possibility of liver damage based on the level of Tylenol in the blood at specific time periods. Also, AST and ALT levels correlate with the stage of toxicity. A medicine called acetylcysteine decreases liver toxicity if given in the early stages of the overdose. For those in liver failure, liver transplant becomes the only option for survival.
