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#1
Old 02-24-2010, 12:46 PM
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How much is a fatal overdose of Tylenol?

At nytimes.com it states that "Dr. Ivins, a microbiologist who had worked with anthrax for decades as part of the vaccine program at the Armys biodefense laboratory at Fort Detrick, Md., took a fatal overdose of Tylenol in July 2008 at the age of 62."

How much is a fatal overdose of Tylenol?
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#2
Old 02-24-2010, 12:49 PM
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From http://drugbank.ca/drugs/DB00316

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The toxic dose of paracetamol is highly variable. In adults, single doses above 10 grams or 140 mg/kg have a reasonable likelihood of causing toxicity. In adults, single doses of more than 25 grams have a high risk of lethality.
#3
Old 02-24-2010, 12:52 PM
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What kind of death would this be? Would you just fall asleep or would there be agonizing stomach cramps/headaches/pissing blood?
#4
Old 02-24-2010, 12:54 PM
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My understanding is that liver failure is an extremely unpleasant condition.
#5
Old 02-24-2010, 02:22 PM
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Overdosing on acetaminophen (or paracetamol outside the US) caused liver toxicity, it damages your liver. The way you die is by liver failure, a really painful and bad way to die, that can take over a week.

I don't know what the LD50 is on acetaminophen off hand, but the maximum healthy adult dose is 4000 milligrams in 24 hours (about 8 extra strength Tylenol). You can overdose on acetaminophen by exceeding this a lot at once, or a little over time, and mixing acetaminophen with anything else that damages the liver (like alcohol) greatly raises the damage either can do alone.

So, to the OP, the amount that person could have taken could vary greatly. It would be impossible to tell more without more information. He could have taken anywhere from 50,000 milligrams (100 extra strength Tylenol), to 3000 milligrams with a 12 pack of beer (6 extra strength Tylenol).
#6
Old 02-24-2010, 02:26 PM
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Quote:
Originally Posted by IAmNotSpartacus View Post
My understanding is that liver failure is an extremely unpleasant condition.
Yea, you'd think a micro-biologist could come up with a better method of doing himself in.
#7
Old 02-24-2010, 03:01 PM
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The lethal dose of acetaminophen is quite variable.
Children handle larger loads than adults, and the underlying health of the liver is an important factor in how capably the toxic intermediaries are tolerated.

As a rule of thumb a single point dose of 140 mg/kg in adults is considered potentially toxic enough to initiate admission and more careful evaluation; more useful are blood circulating levels obtained at some point in time after the overdose (starting around 4 hours), extrapolated against the Rumack nomogram.

It's common to vomit after an acetaminophen overdose, and it's common to take too much over a more protracted period of time, so in practice we have difficulty making hard and fast rules about when to initiate treatment.

While it's one of the commoner overdoses I've dealt with over the years, it's also one of the ones where there always seem to be some mitigating factor or another that screws up a perfectly textbook treatment approach.

http://guideline.gov/summary/sum...11428&nbr=5946 and

http://emedicine.medscape.com/article/820200-overview, e.g.

Last edited by Chief Pedant; 02-24-2010 at 03:02 PM.
#8
Old 02-24-2010, 03:09 PM
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Per the Wiki article, for what it's worth, the claim is that he bought two bottles of Tylenol PM shortly before his death. As mentioned above, ingestion with alcohol can lower the dosage required to cause liver damage.
#9
Old 02-24-2010, 03:10 PM
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Originally Posted by blood63 View Post
What kind of death would this be? Would you just fall asleep or would there be agonizing stomach cramps/headaches/pissing blood?
Disgusting. You turn yellow; you feel horrible; you bleed all over the place and you are in a fog but conscious.

These days it's off to the transplant center as soon as you polish off your liver; always a lovely decision-making tree when the patient was trying to kill himself and post-transplant you need a very cooperative patient with a strong will to live and take personal responsibility for their care.
#10
Old 02-24-2010, 03:14 PM
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Here's Cecil's take on Does Tylenol + alcohol = liver failure? which agrees with what's already been said.
#11
Old 02-24-2010, 04:09 PM
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Originally Posted by Simplicio View Post
Yea, you'd think a micro-biologist could come up with a better method of doing himself in.
Sure -- just using aspirin instead of Tylenol would have done it.
#12
Old 02-24-2010, 06:56 PM
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I thought there was something added to OTC acetominophen that caused vomiting if one took an overdose. Is this true?
#13
Old 02-24-2010, 06:56 PM
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I'd like to respectfully request that this thread not veer any closer to a discussion of better and/or effective methods for committing suicide. I know that info is available elsewhere, unfortunately. And while there's a genuine curiosity relating to the news story the OP describes, I'm also aware that the exact thread title is a very popular google search phrase for suicidal teens.
#14
Old 02-25-2010, 04:48 AM
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Originally Posted by phouka View Post
I thought there was something added to OTC acetominophen that caused vomiting if one took an overdose. Is this true?
No.
However vomiting is an early feature in many acetaminophen overdoses.

To the other two comments above: the toxic dose of acetaminophen is not particularly secret. Aspirin overdose is not a very effective way of doing oneself in.
#15
Old 02-25-2010, 06:42 AM
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Quote:
Originally Posted by IAmNotSpartacus View Post
My understanding is that liver failure is an extremely unpleasant condition.
Although Chief Pedant has already answered this, I cannot resist adding my two cents. Simply put, watching a patient die from a Tylenol OD was about the most gruesome, messy, and godawful death I've ever witnessed.

The worst part was the (spontaneous) bleeding, especially against a background of lemon yellow skin. We're talking about not just bleeding from every orifice in the body (use your imagination), but also in the skin and, worst of all for me to see, under the membranes of the eye. What were the 'whites of the eyes' were now bulging out with blood. And the smell. Blood, vomit, diarrhea, ammonia (from liver failure), all absolutely stomach-turning. And, as noted, the victim will have hepatic encephalopathy to the nth degree. Until they lapse into a coma, this has the effect of adding an almost surreal, animal-like grotesqueness to the whole thing.
#16
Old 02-25-2010, 06:49 AM
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Quote:
Originally Posted by Chief Pedant View Post
Aspirin overdose is not a very effective way of doing oneself in.
And is also not a good way to go - raving with delirium, soaked in sweat, deaf, high fever, rapid deep breathing, hallucinating, stomach bleeding, vomiting, . . . only slightly "better" than a Tylenol OD.
#17
Old 02-25-2010, 11:30 PM
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Quote:
Originally Posted by anson2995 View Post
I'd like to respectfully request that this thread not veer any closer to a discussion of better and/or effective methods for committing suicide. I know that info is available elsewhere, unfortunately. And while there's a genuine curiosity relating to the news story the OP describes, I'm also aware that the exact thread title is a very popular google search phrase for suicidal teens.
In my experience in any number of mental health wards, near suicides on Tylenol did not "do the math." Rather, they bought a large bottle and figured a nice round number would do the trick. (I was told any minimum answers in pills, but I'll skip that.)
#18
Old 02-26-2010, 08:38 PM
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And in addition, there are so many sites that describe drugs and their LD50s that one more mention of it is not going to make the slightest bit of difference in how likely someone is going to find the information they want.
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