Acetaminophen is a derivative of aniline, which is a deadly poison which acts by killing the liver. Aniline is treated to add a hydroxyl in the para position. Then the p-hydroxy-aniline is treated in an addition reaction to add a ketone (O=C-CH3) to it; the ketone carbon adds to the nitrogen, replacing one of the hydrogens. In the liver, the terminal methyl group is cleaved.

Acetaminophen is relatively harmless in those with functioning livers when taken at safe doses. However, the drug should not be taken by those with liver disorders. Overdosage tends to cause acute liver failure, and what basically amounts to a slow, painful death.

For some reason, acetaminophen is often the drug of choice for teenagers making desperate cries for attention by supposedly attempting suicide. Most of the time, they don't actually intend to commit suicide and are only wanting attention, and they mistakingly figure that overdosing on acetaminophen is not going to hurt them. Instances of this nature typically spike in America around the late Spring, where princes and princesses of high school are suddenly beginning to realize that their reign is about to end, and/or their girlfriends or boyfriends really don't care about them for anything other than status symbols, money, and cheap sex.

As with most drugs, people mistakenly assume that if one or two is good, fifty must be better, because they have some severe symptoms this time.

A patient presenting to a medical facility as a possible overdose can expect an NG tube (nasogastric tube) to be inserted, with a lavage of activated charcoal pumped down it. An acetaminophen level will be drawn, along with a full toxscreen, and a battery of other tests. In the case of an acetaminophen overdose, the patient can expect to be admitted to the hospital on suicide precautions, to receive IV hydration therapy, and will be given acetylcysteine (Mucomyst).

Acetylcysteine is used because it is a precursor to glutathione, which is necessary to metabolize the acetaminophen into relatively harmless byproducts.

A brand of acetaminophen

Tylenol is in 4 forms:

Tylenol, without a number, a non-prescription, over-the-counter drug

Tylenol #2, a perscription drug with codeine. Usually 15mg. The label states WARNING:May cause drowsiness. Alcohol may intensify this effect. Use care when operating a car or dangerous machinery.

Tylenol #3 has codeine and is twice the dosage of Tylenol #2, 30mg. All the label says is don't take more than 1 every 3 or 4 hours, and then only as needed. Codeine can cause stomach irritation.

Tylenol #4 has codeine and is twice the dosage of Tylenol #3, 60mg The strongest, usually for extreme pain that the other dosages don't help for.

Tylenol shouldn't be taken very often, it can cause liver damage if you take it very often. One person is rumored to have taken it every day with a glass of wine. Both caused liver failure for him.

The codeine ones are usually used for broken bones or post-op patients. Too much codeine can caue stomach irritation, drowsiness, and in some cases hallucination. A board certified physician or pharmacist knows all the warnings and contraindications, and has a PDR. In the US and Canada, you need a prescription if its anything other than #1.

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