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> He died at a hospital in Seattle. His wife, Cindy Engstrom, said he had injured one of his feet in October, accidentally took too much Tylenol for pain relief
by blinkingled 6y ago
> He died at a hospital in Seattle. His wife, Cindy Engstrom, said he had injured one of his feet in October, accidentally took too much Tylenol for pain relief and suffered liver damage.
As sad as it is to lose a person at age 55, it's even harder to digest the tylenol induced liver failure part until you experience foot injury/pain. I spent last December in excruciating foot pain that came out of nowhere and the thought of wanting to guzzle down entire bottle of Advil/Tylenol touched my mind at least couple times.
Anyway, RIP. Old interview with him - https://www.youtube.com/watch?v=rjZWUweIIEU https://www.youtube.com/watch?v=rjZWUweIIEU
- 1996 6y agoThe lack of easy access to strong painkillers kills people, driven to extreme by the madness of pain. Yet we only talk about the evil of drugs, and the opioids epidemic.
- andromeduck 6y agoWhat is the opioid epidemic?
- I_Suleiman 6y agoWhy would some think excessive Tylenol would be preferable over narcotic pain meds How much Tylenol would a person have to consume over a two month period to permanently damage their liver This is bizarre.
- 1996 6y agoJust consuming more than 4g on one day may be enough to start the liver failure, especially if using alcohol or other drugs. Protip: have some N acetyl cysteine handy. It's freely available on amazon, and it protects your liver from acetaminophen abuse (and helps rebound faster the next day after a night of heavy drinking, but the FDA absolutely hates when people mention that :-) EDIT: replying here as HN things I'm "posting too fast" Whenever in doubt, by default, you take it due to its extremely good tolerance. There are no bad side effects at usual doses, even after 50+ years on the market (well, at very large doses, vomiting, which I think is good in case of acetaminophen or alcohol poisoning) https://en.wikipedia.org/wiki/Acetylcysteine https://en.wikipedia.org/wiki/Acetylcysteine Don't let the FDA make it illegal: https://www.sgtreport.com/2020/08/use-n-acetylcysteine-the-fda-is-trying-to-make-it-illegal-because-it-could-help-treat-covid-19/ https://www.sgtreport.com/2020/08/use-n-acetylcysteine-the-f... https://fda.news/2020-08-21-fda-trying-make-n-acetylcysteine-illegal-could-help-treat-covid19.html https://fda.news/2020-08-21-fda-trying-make-n-acetylcysteine...
- toomuchtodo 6y agoIf you have this on hand, how do you know if and when to administer?
- kridsdale1 6y agoNot a doctor. I just take it when I feel shitty. I figure there is a correlation between not feeling great and oxidative stress in my whole system.
- AdamN 6y agoMany stronger drugs have acetaminophen in them. I've tried oxycontin and had very little benefit. People should know for themselves what works for their pain but never underestimate the damage drugs can do, even if they're over the counter.
- agytvfr 6y ago> How much Tylenol would a person have to consume over a two month period to permanently damage their liver Liver damage can occur after a single incident. People have died from single time overdoses of paracetamol. There is a quick fix in an ER of giving NAC which can help eliminate most of the damage, but there is a small window(a day or two) where it is effective.
- kridsdale1 6y agoI have a load of NAC on hand. Would it be a good idea to take it whenever I take Tylenol? I can't imagine a pharma pathway that would result in it attenuating the painkiller effect. Just mop up the oxidative damage.
- IfOnlyYouKnew 6y agoRead the label. Switch to Aspirin, either completely or half/half. If possible, try fixing the underlying problem, not the pain.
- agytvfr 6y agoNot a doctor and I wouldn't listen to medical advice from HN, but you can find a lot on this: >Therefore, it may be beneficial to administer APAP(Tylenol) in combination with NAC routinely to reduce rates of liver failure and death. Because NAC's main role is to reduce the accumulation of APAP's toxic metabolites, the concomitant administration of NAC should have no impact on the efficacy of APAP as an antipyretic and analgesic. From: https://clinicaltrials.gov/ct2/show/NCT01137591 https://clinicaltrials.gov/ct2/show/NCT01137591 .
- monocasa 6y agoI've seen probably a dozen people in my high school class die from their narcotic pain meds originally prescribed to them. I only took a quarter of what was prescribed after surgery from shattering my leg, and yet weening off was worse than the pain from the injury. I don't blame him for the choices he made, having been there.
- CamperBob2 6y agoUnless your local pharmacist is a serial killer, this stretches credulity.
- tt433 6y agoHow?
- CamperBob2 6y agoA dozen deaths in one HS graduating class? Really? That would raise suspicions on 'Dexter.'
- tt433 6y agoYou're referencing media I don't know, I don't understand why you don't think the scope of the opioid crisis that has claimed thousands could involve the deaths of 12 people with 1 thing in common. Pill mill pharmacies are a thing, and some of those pharmacists have been charged with crimes.
- astrange 6y agoHe means a year in HS, not a single classroom. That's a few hundred people. And the way pharmacies were handing out opioids it's quite possible. Wasn't called a crisis for nothing.
- monocasa 6y agoYeah, ~1200 person class.
- blinkingled 6y agoIn my case I went to the doctor only after trying to bear it for as long as I can - they did an x-ray and said there's nothing wrong with your foot and you'll just have to ride it for some days. Heck the doctor asked me to eat Turmeric pills - not even kidding. He made sure I wasn't getting a narcotic - and I wasn't looking for it because I am really afraid of side effects. (My wife is the same way - brave woman went without touching the narcotic meds after tooth removal.) That pretty much leaves you with OTC pain meds - I know in these cases probably narcotics of the right kind in restricted doses sound much better but I am just truly afraid of side effects because of what we saw earlier in life.
- whammywon 6y agoI've had pretty much the same experience (minus the recommendation for Turmeric). Once I was lucky enough to get a steroid prescribed and it worked wonders compared to a dose of Ibuprofen every 4 to 6 hours.
- quicklyfrozen 6y agoI know someone who ended up hospitalized from accidentally taking two over-the-counter meds that both contained Tylenol. It just doesn't take that much to cause damage.
- renewiltord 6y agoHonestly, this one does surprise me. American doctors give out opioids like nobody's business. They give you narcotic painkillers for post-tooth-extraction pain! That's ridiculous! The problem, I think, is that many people are foolish enough to "return their unused prescription". I never do that. I make sure to retain unused drugs to their true expiry. It must have been really quite painful. Still, I'd strongly recommend keeping drugs of all manner handy if you've got good self-control around them. They have high utility.
- astrange 6y agoMine gave me high strength ibuprofen and percocet after wisdom tooth removal. I didn't take either because it didn't hurt, but they called me up after to make me take the ibuprofen - apparently the anti-inflammatory effect is needed for healing or something.
- renewiltord 6y agoI took the ibuprofen too. I didn't get mine done in America so sadly no emergency Percocet in my cabinet.
- blargmaster42_8 6y agoThanks Obama! Obama care change some rules so that doctors can be sued if they do not give proper pain relief.
- whammywon 6y agoThe DEA has cracked down tremendously on healthcare providers that over-prescribe opioids, though. Granted I'm sure there are many who still prescribe them like crazy, but it seems like active measures are being taken to curb it.
- renewiltord 6y agoThat's unfortunate. I've always wanted backup in case I really need it. Pity that we policy society by its least capable but I understand why it's necessary.
- IfOnlyYouKnew 6y agoIt's quite common. At least in Europe, available sizes of Paracetamol were severely limited not too long ago because it was the leading cause of overdose deaths. Individual risk isn't exactly high, but OTC painkillers are ubiquitous. Both accidents and suicide attempts are/were frequent. It's a rather terrible way to die, IIRC, with excruciating pain and entirely too much time to regret the decision/accident.
- jartelt 6y agoTylenol is surprisingly easy to overdose on and is well known to cause liver damage. This is especially true if you take extra strength tylenol. It is recommended to stay below 3,000 mg of tylenol within 24 hours, which is only 6 extra strength pills. If you take a bit extra and get over 4,000 mg per day for multiple days, you can get major issues. There just is not much margin for error with tylenol. I think people often get confused because you can typically take a bunch of ibuprofen pills for pain and there are rarely serious side effects. But ibuprofen and tylenol are much different in this regard, despite the fact that both relieve pain and both can be easily bought in a drug store.
- antisthenes 6y ago> This is especially true if you take extra strength tylenol. It is recommended to stay below 3,000 mg of tylenol within 24 hours, which is only 6 extra strength pills. If you take a bit extra and get over 4,000 mg per day for multiple days, you can get major issues. There just is not much margin for error with tylenol. Huh? To actually think that taking 6 extra strength pills in 24 hours isn't enough margin of error? I mean maybe if the person is completely clueless and doesn't read the medicine instructions. Honestly, if you're in that much pain that you're gobbling up 6-8 extra strength pills per day, every day, you should be in the hospital with an IV hooked up, or addressing the chronic pain issue that's causing it. Or have the doc prescribe you something way stronger.
- cameronh90 6y agoI don't know about other people, but for me paracetamol does very little, so if I had even moderate pain I could see why I would be tempted to take too much. On the other hand, UK has OTC ibuprofen+codeine which can fix essentially anything.
- antisthenes 6y agoRight. OTC painkillers are usually not meant for moderate+ pain, at least the stuff available in USA. They're meant for taking you from 3/10 to 1/10. I know most people don't think about it in-depth, but surely we can expect at least some basic logic from them? Like don't swallow pill #6 if the first 5 extra strength pills did nothing.
- dragontamer 6y agoTylenol is over-the-counter, while you need a doctor to prescribe narcotics. As such, Tylenol overdose is more common. The labels are very clear about how much to take, but when you're in chronic pain, you may not be thinking much about the warning stickers or labels.
- AdamN 6y agoTylenol is really not to be abused. Much better to go heavy with Ibuprofen and remember the old-time drugs like aspirin as well as new ones like naproxen. But really a doctor/nurse is critical if the pain is going on for more than a day or two.
- shock 6y ago> Much better to go heavy with Ibuprofen Do you know that Ibuprofen can cause morphological changes in the testes? I wouldn't call that much better...
- khuey 6y agoIt's a lot easier to live without testicles than without a liver.
- OJFord 6y agoNSAIDs (such as ibuprofen) are rough on the kidneys. I didn't know about GP's point, but of course that fits, anatomically.
- philjohn 6y agoYet many people take paracetamol without issue - you just need to read what the max dose you can take is (2x500g tables at least 4 hours apart and no more than 4 times per day) and not for more than a few days at a time. The bigger danger is people mixing it with other cold and flu medication that ALSO contains paracetamol.
- khuey 6y agoParacetamol/acetaminophen has an extremely small therapeutic range for an over-the-counter drug. Yes, if you follow the dosing instructions (and are aware of all sources of the drug you're taking and also aren't drinking alcohol or something simultaneously) you'll be fine, but if you discovered this drug today the odds that it would be approved for over-the-counter use are basically zero.
- smabie 6y agoDoubtful. He was probably addicted to vicodin or some other opiate that is mixed with tylenol
- neogodless 6y agoOff topic: Did you identify the problem? Was it gout? It seems awfully silly for a random internet stranger to diagnose your issue from "excruciating foot pain that came out of nowhere" but... I had basically that off and on again for seven years before it was correctly diagnosed and treated. (As a healthy, active, relatively young person, gout wasn't suspected, but eventually an MRI gave a clue, and blood tests confirmed it.)
- blinkingled 6y agoI got an X-Ray and it showed nothing. The doctor basically thought I was there to score narcotics but he wasn't going to get me any (I wasn't looking for them either but was told to eat Turmeric pills believe it or not - I did and don't have any way to know if it helped.) Does gout come and go - I have not had trouble since then. If it returns I will be sure to do a blood test - and I really appreciate you asking. I am always for problem solving with or without strangers help :)
- neogodless 6y agoYes it comes and goes. In my case, the initial pain was relatively sudden, throbbing, enough to keep me awake at night. I also got an x-ray which doesn't tend to indicate gout, but did show some mobility issues (hallux limitus/rigidus) which were treated with increasingly expensive orthotic inserts.... and it went away after the initial issue for five years. Then it came back, new custom inserts (and some naproxen), went away for another twenty months. When it came back, it kind of stuck around, not the full on pain, but a dull aching that just wouldn't quit, thus the more thorough investigation. In my case, I think the causes were a combination of gout triggers - not enough hydration, alcohol intake, high protein diets, etc.
- blinkingled 6y agoI drink plenty of water - rarely drink alcohol but diet on the other hand may not have been all that good in the past although now I am on a lean one and move around a lot - I will definitely check for gout if it happens again. Thanks for bringing this up - it was bugging me on and off that I had something happen that I don't know the root cause for!
- jychang 6y agoHoly shit. That's insane. People don't realize how terrible it is to die from tylenol induced liver damage. That's often considered one of the worst ways to commit suicide. You're in an incredible amount of pain for a long time.
- dctoedt 6y ago> That's often considered one of the worst ways to commit suicide. I came close to seeing that first-hand some years ago: My (widowed) dad suffered a long, agonizing death from a form of leukemia. I was with him, at his house, for his final week, with a hospice nurse checking in periodically. He refused morphine and instead took a fair amount of acetaminophen; for calories, he drank a lot of beer and V-8 juice mixed together. I warned him about the danger of mixing alcohol and acetaminophen; he immediately perked up, thinking that would be a way for him to end things. He was disappointed when I explained that it wouldn't be a quick death: he'd just wreck his liver and be in even more agony. (He died a few hours later.)
- asveikau 6y agoSorry for your loss.
- rodgerd 6y agoI only learned about it because a local soap opera[1] made it a plot point in the early/mid 90s. [1] Shortland Street
- fctorial 6y ago> You're in an incredible amount of pain for a long time. Just take some tylenol.
- Wowfunhappy 6y agoBoth of my parents are physicians, and both have worked in emergency rooms at some point in their careers. One thing they've taught me is to be cautious about taking too much Tylenol. At the right dose, Tylenol may well be the safest pain medication we have, even compared to Advil, which can occasionally cause problems if taken regularly over a lifetime. However, the gap between a useful dose of Tylenol, and the amount of Tylenol which will kill you, is relatively small compared to similar medicines. My parents say they've watched a lot of people die in the hospital from Tylenol overdoses. There is an antidote, but only if you get it in time.
- wincy 6y agoWow, we recently had a scare with our five year old passed out in her room with a bottle full of Tylenol strewn about. Getting an artery stick on a five year old is one of the most awful things I’ve had to endure, but I wasn’t going to trust a five year old on whether she had taken the pills or not. Turned out she hadn’t taken any! But it was super scary, Tylenol poisoning is no joke, and we have lock boxes for all our medications now.
- balls187 6y agoI'm so glad to hear she is okay. Amazing how effective those child proof containers are at vexing adults, and how ineffective they are for children.
- vvillena 6y agoAdults see a hassle, kids see a challenge. It's almost a counter-incentive.
- csharptwdec19 6y agoOr, worse, your kid is that kid that sees it as "Oh, I can open this, I must be a grown up then"
- krebs_liebhaber 6y ago
- heydonovan 6y agoThis is scary to read, as I've been there. All my friends know not to give me Tylenol. I think on two occasions now I had slight pain and took maybe two or three extra strength Tylenol, and was found on the floor shivering, sweating, waiting for death. This wasn't even an OD, this was recommended dosage. I don't think I'll ever take Tylenol again, I'll deal with the pain. This felt like my kidneys were on fire and not so much liver, so what do I know.
- toast0 6y agoBased on having that reaction, I wouldn't suggest you take Tylenol again. For others, the recommended dose of extra strength Tylenol is two 500mg tablets; but if you only have a minor pain, you don't need to take two tablets, or you could take regular strength (325mg), again the recommendation is two tablets, but you can take less. More than 1g in one dose, or 3g over a day is extremely inadvisable. Acetaminophen (paracetamol) is toxic at a small multiple of the recommended dose; prescription strength acetominophen products add other active ingredients, they don't add more acetaminophen; as opposed to ibuprofen where prescription strength is just more ibuprofen. I'm not a doctor, this isn't medical advice, etc.
- dragontamer 6y agoOne of my classmates died of Tylenol overdose when I was younger, so this lesson was imparted upon me rather quickly. She wasn't that close to me personally, but still, its a lesson I won't forget. In that case, she got into a car accident and started taking Tylenol for some chronic pain related to the accident. A few months later, she was dead.
- sn_master 6y agoI...was in a car accident last Tuesday and been taking Tylenol like crazy. They refused to give me any prescriptions because I didn't have broken bones, despite the impact going 84 mph to zero in subsecond. Thank you! Do you know what's a good alternative to Tylenol? My chest and shoulder are hurting like hell.
- snuxoll 6y agoWas it just the ED that refused you? Would be wise to go speak with your primary care provider and get their input, if you don’t have one it’s time to get one (if nothing else having one physician who has a complete history on you is a huge benefit).
- sn_master 6y agoThe cop gave me a ride to the ED/ER after the accident, and the dr literally said "your x-ray is fine, take Tylenol or Ibuprofen" and just opened the door and left! Didn't talk to him more than two minutes total before and after the x-ray. They charged me 1,008 USD for that! The X-Ray itself was a separate charge by Radia and was just twenty bucks! The nurse said the pain should improve within a week, but its been so already and I am still in pain even when I breath or move my arm up. I'll tough it up for another week before seeing a Dr. I can handle the pain (had double kidney stones, one in each kidney before). Ah, also, FYI for folks in the US: Do not reject Personal Injury Protection. The insurance agent told me my primary insurance will cover me, but then the hospital and my lawyer said that's false and insurance companies reject to pay hospital bills for auto-accidents. Later, they said they'll try to get a formal denial from my auto-insurance first and then try and see if my primary insurance will pay for it.
- Aaronstotle 6y agoI heard that if Tylenol was released today as a new drug, the FDA would not approve it, which is kind of scary to think that it's on shelves now.
- sn_master 6y agoWhat's the alternative? Ibuprofen? Aspirin?
- ce4 6y agoHmm, acetaminophen/paracetamol is listed here next to aspirin, ibuprofen and opioids are also listed there. I don't think it would not be approved at all, maybe not for over the counter sale. Here in Germany you get it only in pharmacies. No prescription is needed for buying up to 10g of active substance per visit. https://en.m.wikipedia.org/wiki/WHO_Model_List_of_Essential_Medicines https://en.m.wikipedia.org/wiki/WHO_Model_List_of_Essential_...
- trollied 6y agoIt’s called Paracetamol in the UK. We can only buy small packs of it (16 tablets or so) to try and prevent things like this. It’s very very rare to see Paracetamol issues in the UK news. A great man, a crying shame.
- bigtones 6y agoYes, that is one of the things I was amazed with when I moved from Australia to the USA. You can buy Acetaminophen over here in America in jumbo size 500 or even 1000 tablet containers over the counter - that's a lot of a pretty powerful drug.
- fctorial 6y ago10 tablets OTC is exactly same as 1000 tablets OTC.
- winter_blue 6y agoReading this whole thread, it almost seems like an opioid or an opioid combined with naloxone (suboxone?) would be rather safer than tylenol/acetaminophen. At least with opioids, the risk of overdose is far more widely understood, and a remedy to overdoses (naloxone) exists, in case it happens. There is the downside of its addictiveness, but in particularly severe cases of patients suffering from really bad pain, it sounds like controlled, limited doses of opioid-based pain killers might be safer? I'm not a doctor, I'm just wondering.
- deleted 6y ago[deleted]
- bigtones 6y agoTylenol is deadly, the difference in the dosing between Children's Tylenol and Infants Tylenol has also unfortunately killed many babies - Acetaminophen is a very powerful drug. The FDA failed to fix it for more than 15 years during which many children died of Tylenol overdoses. https://www.propublica.org/article/tylenol-mcneil-fda-kids-dose-of-confusion https://www.propublica.org/article/tylenol-mcneil-fda-kids-d...
- parasubvert 6y agoIt’s bizarre that in the USA they didn’t label infant Tylenol dosage. It’s labelled in other countries. We used infant Tylenol whenever our baby had a fever or otherwise was fighting off a cold. The dose size for children’s Tylenol goes way up (5ml). You'd think something was up when the syringes they give you for the infant type are max 2 ml.
- legohead 6y agoI smashed my middle toe into a table while play-chasing my dog around the house. I was instantly in enormous pain, but able to hobble around. Later that night, I was in so much pain that I literally could not walk at all. I was laughing and crying at the same time, it was ridiculous that I was in so much pain over a TOE. Not even the big toe at that. I had to crawl to the bathroom to pee. Luckily it just took another day and I could hobble on it again.
- carabiner 6y agoI heard somewhere that under 40 (or was it 45?), most people die of suicide or trauma. After that, people can die of pretty much anything. Just goes to show...
- liotier 6y ago> accidentally took too much Tylenol for pain relief and suffered liver damage For non-USians, Tylenol is a brand of paracetamol. The recommended maximum daily dose for an adult is three to four grams. Paracetamol toxicity is the foremost cause of acute liver failure in the Western world.
- fctorial 6y agoAlso known as crocin.
- jlarocco 6y agoI'm not sure if it's true, but I recall reading that Tylenol is the most commonly overdosed and misused drug. Combined with alcohol it'll destroy your liver, even in low dosages.
- cityzen 6y agoI have gout and when it flares up it is the worst. I am in serious foot pain for anywhere from a week to a month or longer. Currently I'm dealing with a buildup of gouty tophi on my heel that has been there for a few years and finally surfacing and causing real issues. I thought it was just a callous from walking with flip flops for too long or something, but nope, just more gout coming around to ruin my days. It is very depressing that, on top of the pain, I feel like I'm constantly making excuses why I can't do things with my family. Often times I will "power through it" and just make things worse. Nowadays I am quick to get on my crutches and keep my foot elevated at any hint of a flare up. I did not know of Eric but can certainly understand taking too much Tylenol for foot pain.
- Karupan 6y agoAs someone who takes paracetamol instead of NSAIDs (ibuprofen, aspirin) because of increased sensitivity, this scares me. I do have a hard cut-off of three 500mg tablets in 24 hours, and I never take more than 500mg in a 6 hour period. I should ask my doctor for a non-NSAID alternative painkiller.
- mensetmanusman 6y agoTylenol overdose is too common. I doubt the medicine would be legal today if someone tried to release it now.
- tw04 6y agoUgh, it is shocking how many people don't seem to realize what acetaminophen does to the liver. I had buddies who used to pound tylenol after a long night of drinking to try to help a hangover in college. I'm actually kind of shocked this didn't happen to any of them. PSA: don't drink and take tylenol, please. The warnings on the bottle aren't a joke.
- thorin 6y agoI find it highly confusing how Americans seem to always reference branded medication. In the UK people generally take generic Ibuprofen (an NSAI) or Paracetamol at a standard does e.g. 500mg for paracetamol. Over time this seems way less confusing. There are quite a few branded versions but once you have an idea of the component parts it seems far less confusing to understand what you are taking. The BNF provides some accessible guides to all pharmaceutical drugs: https://bnf.nice.org.uk/drug/ibuprofen.html https://bnf.nice.org.uk/drug/ibuprofen.html https://bnf.nice.org.uk/drug/paracetamol.html https://bnf.nice.org.uk/drug/paracetamol.html I don't mean to be insensitive RIP to what sounds like an awesome guy
- physicsguy 6y agoI don't think it's that uncommon, plenty of people would say 'Nurofen' in the UK as well.
- thorin 6y agoThey might, but I think this is particularly common in the US due to the mandated branded medication in many healthcare scenarios even for drugs with lapsed patents. I think most younger, educated people in the UK would refer to them by the generic names.
- Tade0 6y agoI share this sentiment. Not knowing that "Tylenol" is Paracetamol I assumed it had to be some heavy, special, US-only painkiller, like those opioids which killed so many. I have a box of this in my drawer - it's 20 pills totalling 10g - that's enough to damage a healthy liver if taken in the span of 24h. I can't imagine the pain this man must have been going through to do this and mind you, I had kidney stones.
- chx 6y agoNot sure what he took... Some versions of Tylenol have codeine in them as well. I got some stronger ones (Tylenol 3) after oral surgery and I had a few pills left and when a few months later my back was acting up and I was eyeing those pills I immediately flushed them down the toilet because I don't want to get addicted to that shit. See https://en.wikipedia.org/wiki/Codeine/paracetamol https://en.wikipedia.org/wiki/Codeine/paracetamol here.