Notify the physician if your patient complains of acute abdominal pain. Abdominal pain may be a sign of pancreatic injury caused by significant hepatotoxicity. Pancreatic injury is assessed by obtaining lipase and amylase levels.

Acetaminophen crosses the placental barrier. A pregnancy test (concentration of human chorionic gonadotropin) should be obtained in all women of childbearing age who are suspected to have ingested a toxic amount of acetaminophen.

Because Amanda's overdose was intentional, a psychiatric consult has been ordered.

And of course, don't forget psychological support. Hospitalization can be scary, especially for a 16-year-old girl, and the treatments given for an acetaminophen overdose can be uncomfortable and humiliating.

When you report to work the following day, you find that Amanda's ALT is slightly elevated and her blood acetaminophen concentration is 4 ug/mL. Her AST, PT and blood glucose level are within normal limits. The physician has therefore written an order for Amanda to be discharged home.

Because the liver can regenerate if not too severely damaged, Amanda will not experience long term complications from her acetaminophen overdose. If her liver had been so severely damaged that it could not regenerate, the physician may have discussed the need for a liver transplant with Amanda and her mother.

When taking care of an accidental or intentional acetaminophen overdose patient, it is essential that the nurse knows how acetaminophen can cause hepatotoxicity. He or she needs to understand how blood
tests such as ALT, AST, bilirubin and PT can indicate liver damage.

The nurse administering acetylcysteine, an antidote for acetaminophen overdoses, needs to know how to prepare and administer this drug. The acetaminophen overdose patient must be continuously observed for gastrointestinal distress, rashes, mental status changes, coagulopathy,
hypoglycemia and pancreatitis.

Although not all acetaminophen overdose patients will survive, proper nursing care can help increase the comfort and decrease the mortality rates of these patients.

1. Dennis Lee, MD, Jay W. Marks, MD, ATylenol (Acetaminophen) Liver Damage@, http://www.Medicinet.com (Feb, 2009).

2. A conjugate is formed by the union of two compounds.

3. An acetaminophen nomogram is only used with a one-time ingestion of pediatric, regular strength or extra-strength acetaminophen. It is not accurate when extended-release acetaminophen is taken, or when multiple doses of acetaminophen are taken over a period of
time.
 

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