Comment by mmooss
20 hours ago
The Pubmed articles are from 20 years ago. The 2023 JAMA article has some qualified information:
"In 2021, US poison centers received more than 80 000 cases involving an acetaminophen product.1 The National Electronic Injury Surveillance System estimated that 78 414 emergency department (ED) visits occurred annually in the US from January 1, 2006, through December 31, 2007, for overdoses of acetaminophen-containing products.2 In Canada, approximately 4500 hospitalizations occur each year because of acetaminophen overdose.3"
It doesn't tell us risk. Acetaminophen is very widely used, potentially the most widely used drug. I'm not sure what these numbers represent in terms of risk.
What those numbers really don't get into:
~80% of acetaminophen poisoning cases severe enough to end in hospital are intentional suicide attempts.
Those patients also have better outcomes though: family members know what happened, they get them to a hospital, they can take N-acetylcysteine as a timely antidote.
In the unintentional poisoning group, ~90% is from multi-day accumulation, they don't realize they've been poisoning themselves. They have a much higher rate of acute liver failure and death.
https://doi.org/10.1186/cc1475 https://doi.org/10.1016/j.cld.2013.07.001 https://doi.org/10.1097/mcg.0b013e31818a3854
Regarding the unintentional overdoses:
"There are two distinct clinical syndromes described in literature. One is the 'garden variety', wherein the patients ingested large amounts of acetaminophen with a suicidal intent .... The other pattern is seen in chronic alcoholics who ingest smaller amounts of acetaminophen in an attempt to relieve pain ...."
"The causes of chronic pain in the accidental overdose group were toothache, chronic backache, or headache."
https://link.springer.com/article/10.1186/cc1475
Yes, and those alcoholics also exactly fit the multi-day accumulation pattern. These aren't people taking one day of Tylenol after a bender for a hangover. The pattern is people with an impaired ability to process acetaminophen (alcoholics) taking multiple days of doses they can't handle (their daily safe dose is about 1/2 of normal) for chronic pain (like chronic back pain).
With cost of healthcare, inflation, unemployment, housing crises, wars and whatever else folks have to be thrilled about these days, I am willing to risk assuming alcohol consumption is not going to be on a permanent downward trend. And pain management is far more challenging now than it was 20 years ago, many having no other option beyond NSAIDs for serious problems. That's not hard data, but it is me being quite confident that whatever the numbers were then, won't remain all time highs if they ever were or aspired to be.
Also, I do not work too hard around here, especially with all the corporate aligned types that patrol the area. Folks can do their own research, while they can, before history is rewritten by LLMs and the new internet. Yeah, a lot of articles and papers are getting more difficult to find. And institutional capture is well underway with AI. Newer generations think because they can't find something, it never existed. This is HN, with a karma economy and high price on honesty. I am just leaving occasional marks in the gray zones.