Forensic Pathology for Police - Brainshare Public Online Library

Over-the-Counter (OTC) Drugs 285
Acetaminophen
Acetaminophen (Tylenol) is a very commonly used analgesic (pain reliever) and
antipyretic (anti-fever) OTC drug. Routes of administration include oral and rectal
(suppositories). A lethal dose in an adult is considered 20 g, while in a child, as little
as 4 g can be lethal. A blood concentration >160 mg/L is considered toxic. If a very
large amount of the drug is ingested, death can occur relatively quickly (Fig. 11.26).
If lesser, but still toxic, amounts are used, the patient may initially survive, and
progress through four stages of poisoning: I (24 hours) – gastrointestinal distress;
II (1–2 days) – apparently better, but with ongoing liver damage; III (3 days) –
jaundice, coagulation problems, continued liver damage; IV (4 days−2 weeks) –
liver failure and death. Under the microscope, the classic pattern of liver destruction
is described as “centrilobular necrosis.”
Fig. 11.26 The gastric
contents of a man who
committed suicide by
ingesting three entire bottles
of Tylenol. Note the abundant
pill residue within the
container
Aspirin (Salicylate)
Aspirin represents another very commonly used OTC drug. Besides having analgesic
and antipyretic properties, aspirin also has anti-inflammatory and anti-blood
clotting effects. The usual route of administration is oral. The lethal dose is said to be
between 2 and 5 g. The toxic blood concentration is 500 mg/L. Persons experiencing
aspirin toxicity tend to proceed through three physiologic phases: respiratory alkalosis,
metabolic acidosis, and hyperthermia. Children taking aspirin during a viral
respiratory illness are at increased risk of developing Reye syndrome, characterized
by severe liver damage and possible death.