Question

Scenario (page 48)

A 59-year-old man came to the emergency department because of nausea and vomiting, a slight fever, abdominal tenderness, and jaundice. Upon examination, he admitted drinking as many as 12 servings of alcohol per week, which he had done for the past ten years. Because of a recent injury to his knee, he had been taking up to eight 500 mg tablets of acetaminophen every day for the past two weeks. Tests revealed elevated liver enzymes, bilirubin, serum glucose, and blood acetaminophen concentrations.

Critical Thinking Questions:

1. What is the likely outcome of the combination of regular alcohol intake with acetaminophen?

2. What is the maximum daily dose of acetaminophen for an average adult?

3. How prevalent is acetaminophen overdose in relation to acute liver failure?

4. What other issues and problems are related to acetaminophen or alcohol intake?

Answer 1

Answer 1: Acetaminophen is a kind of paracetamol which people use to reduce pain and fever. Generally consuming alcohol while on medication is strictly prohibited however, a combination of alcohol and acetaminophen increases the chances for liver damage. Some of the common side effects observed while consuming both these substances are stomach ulcers, fatal liver damage, etc. This occurs because acetaminophen itself has a severe impact on the liver termed as hepatotoxicity. Upon which consuming alcohol produces another set of toxins which the liver again has to breakdown exerting a tremendous amount of load on the organ leading to its failure.

Answer 2: According to the US national library of medicine, acetaminophen should not be consumed more than 3,000mg for an adult. Also, the drug should not be consumed more than 10 days or only 3 days in succession for fever.

Answer 3: When a person consumes acetaminophen most of the drug is utilized by the body and the excess is broken down for the body to excrete out via urine, bile or processing through the kidney. Some amount of this drug is converted to a toxin called NAPQI by the human digestion system. This toxin has to be eliminated from the body which is the main purpose of the liver. the organ produces an antioxidant called glutathione. When there is an overdose of the drug, the liver is not able to secrete sufficient amount of glutathione required to breakdown the excess of toxin produces thus leading to acute liver damage.

Answer 4: A review carried out in 2016 states that the chances for liver damage in alcohol abused consuming the drug are higher than people who are just overdosed by the drug. Some other major problems that are included due to combined consumption are jaundice, pain and swelling gin the abdomen, vomiting, unusual bleeding of the skin and loss of appetite.