Thursday, June 13, 2013

Acetaminophen Overdose

10 days ago I had oral surgery.  A cavity developed under a crown and spread into the roots and jawbone. So my dentist had to remove the roots and part of the bone to eliminate all the cavity.  She inserted a bone graft and sutured the hole, which will need to heal for about 6 weeks before she can insert a bridge tooth.

My dentist warned me to take a painkiller before the injected anesthetic completely wore off. She offered to write a prescription for a painkiller.  However, I assumed prescriptions were required for heavy duty painkillers like Percoset, Demerol, etc.  Years ago after outpatient surgery I took one Percoset tablet and then threw up for 72 hours. When I was later prescribed Demerol, I had to also take an antiemetic to prevent throwing up the Demerol, because I don't tolerate heavy duty painkiller drugs.  So I declined my dentist's offer of a prescription.

 Neither will I take NSAIDs like Alleve or Ibuprofen, which can cause reflux or harm sensitive stomachs (I've already had damage from H. Pylori infection).   I told my dentist that I'd be okay with just taking acetminophen (Tylenol).  She warned me not to exceed 8 tablets daily, but to take 2 tablets per dose.

I didn't get home (to my acetaminophen bottle) until after the dental surgery anesthetic had definitely worn off and I experienced obvious mouth and jaw pain.  So I took my first 2 acetaminophen tablets about 2 pm and only too 2 more doses that day for a total of 6 tablets (500mg each). 

The next day I took my first tablets about 6am. I noticed I felt a little nauseas and no appetite, which worked well for chewing restriction (on one side of my mouth to avoid the surgery area).  I decided that I needed to get another bottle of acetaminophen, because at the rate of 8 tablets per day, I would run out soon.  However, the second bottle (also generic) suggested that no more than 6 tablets be taken per day (vs. 8 per day on the previous bottle).  So I only took 6 tablets the second day as well. 

However, on the second day I noticed stomach pain as well as nausea and loss of appetite.  Around bedtime I experienced some serious refluxing.  I already have hypochloridia (my stomach doesn't produce enough acid), which means I won't take antiacids or acid blockers. So I dealt with the reflux by drinking sips of cool water.  Eventually reflux turned into serious nausea which turned into uncontrollable vomitting.  After that I was finally able to go to sleep. 

The next morning I took 2 acetaminophen to cope with mouth/jaw pain, but I also had diarrhea that morning in addition to mild nausea, stomach pain and lack of appetite.  I knew I hadn't consumed any allergens or foods which cause reflux. So I started to consider what was different, when I recalled that acetaminaphen can cause overdose symptoms. 

I research acetaminophen overdose symptoms and found those matched what I experienced during the past 2 days.  However, I definitely had not exceeded the recommended dose on the package. Then I wondered if there was any standard of how much the 'average adult' taking acetaminophen weighs, because I weigh below average for my height and age.  I found nothing for adults, but I did find a dosage per weight chart for infants and children.  I just happen to weigh the highest weight mentioned for children (under 100 pounds). A child of that weight should take 1 (500mg) tablet per dose not to exceed 5 tablets per day. 

For my weight (not my age) I had exceeded the recommended acetaminophen dose, not by much, but enough to get mild symptoms (stomach upset, vomitting, etc.).  Fortunately I hadn't taken enough to get serious overdose involving liver damage and a quick trip to the ER to get my stomach pumped.  Needless to say, I took no more acetaminophen that day or even after my next dental appointment a week later, when I had a cavity removed from another tooth.  I had slight discomfort after the dental anesthetic wore off, but not enough to risk acetaminophen overdose again.  I continued using ice packs and gargling with warm salt water for the surgery site.

After I told my dentist about my experience with acetaminophen, she said that's the most common drug overdose.  People, like me, assume acetaminophen is safe, because it doesn't irritate the stomach like NSAIDs or aspirin or narcotic painkillers.  However many other drugs contain acetaminophen. So people can easily overdose by popping a few acetaminophen tablets while taking another drug. Other people like me (maybe other underweight celiacs) can easily overdose if they follow package instructions for adult doses of acetaminophen.

 If I ever really need a painkiller, I might take ONE accetaminaphen caplet and not exceed 4 daily.  However, mouth pain is so mild compared with the gut pain I had with undiagnosed celiac disease.