Acetaminophen clinical presentation

NSAIDs are a reasonable alternative when acetaminophen fails to provide an acceptable analgesic response. Some authorities recommend NSAIDs over acetaminophen for patients presenting with severe pain or signs and symptoms of inflammation, but this is a matter of much contention. The rationale for this recommendation is that acetaminophen s central mechanism of action renders it ineffective against peripheral joint inflammation, and therefore, less effective.18 Consensus guidelines support the use of NSAIDs as an alternative to acetaminophen if clinical features of peripheral inflammation or severe pain are detected.11,12 Unfortunately there is no validated mechanism to identify patients who are more likely to respond to NSAIDs than acetaminophen. 

W lb i a 19-year-old female coHege sophomore who presents to the student health clinic witii a 3-day history of dysuria. LO s last menstrual period was 2 weeks ago. She is sexually active, and uses a diaphragm with spermicide for birth control. Her medications include ferrous sulfate and acetaminophen. She has NKOA. 

CNS depression is the most frequently reported clinical effect. The typical overdose patient may present with extreme somnolence that may progress to frank coma. Miosis is usually present unless the individual is acidotic or has suffered hypoxic brain injury. Respiratory depression can occur and may progress to respiratory arrest. Pulmonary edema may be seen. Bradycardia, hypotension, and hyperthermia can develop. Hydrocodone is often combined in products with acetaminophen therefore, patients should be evaluated for hepatotoxicity secondary to acetaminophen overdose. Available opiate immunoassays cross-react unreliably with hydrocodone. Peak therapeutic serum levels are 0.024 mg 1 toxic levels have been reported to reach 0.1-1.3 pgml , but are of little prognostic or therapeutic value. 

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