Liver damage / tylenol

this article is from yahoo news . just think what our livers go through when we combine drinking,a oral steroid cycle AND over the counter pain meds like tylenol .
WASHINGTON - Think popping extra pain pills can't hurt? Think again: Accidental poisonings from the nation's most popular pain reliever seem to be rising, making acetaminophen the leading cause of acute liver failure.

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Use it correctly and acetaminophen, best known by the Tylenol brand, lives up to its reputation as one of the safest painkillers. It's taken by some 100 million people a year, and liver damage occurs in only a small fraction of users.

But it's damage that can kill or require a liver transplant, damage that frustrated liver specialists insist should be avoidable.

The problem comes when people don't follow dosing instructions — or unwittingly take too much, not realizing acetaminophen is in hundreds of products, from the over-the-counter remedies Theraflu and Excedrin to the prescription narcotics Vicodin and Percocet.

"The argument that it's the safest sort of has overruled the idea that people cannot take any amount they feel like," says Dr. William Lee of the University of Texas Southwestern Medical Center, who laments that acetaminophen is popped like M&Ms.

Acetaminophen bottles currently recommend that adults take no more than 4,000 milligrams a day, or eight extra-strength pills.

Just a doubling of the maximum daily dose can be enough to kill, warns Dr. Anne Larson of the University of Washington Medical Center.

Yet, "if two is good, 10 is better in some patients' minds," she says with a sigh.

The Food and Drug Administration has long wrestled with the liver risk, warning two years ago that more than 56,000 emergency-room visits a year are due to acetaminophen overdoses and that 100 people die annually from unintentionally taking too much.

A study published this month by Larson and Lee has agency officials weighing whether to revisit the issue.

Over six years, researchers tracked 662 consecutive patients in acute liver failure who were treated at 22 transplant centers. (Acute liver failure is the most severe type, developing over days, unlike chronic liver failure that can simmer for years because of alcohol abuse or viral hepatitis.)

Almost half were acetaminophen-related. More remarkable was the steady increase: Acetaminophen was to blame for 28 percent of the liver poisonings in 1998, but caused 51 percent of cases in 2003.

That makes acetaminophen the most common cause of acute liver failure, the researchers report in the journal Hepatology.

While most patients pulled through with intensive care, 74 died and 23 others received a transplant.

Some 44 percent of the cases were suicide attempts.

But more, 48 percent, were unintentional overdoses, which "isn't hard to do," Larson says.

Say you take Tylenol Cold & Flu Severe for the flu's aches and stuffiness — 1,000 mg of acetaminophen, every six hours. A headache still nags so between doses you pop some Excedrin — 500 mg more of acetaminophen. Switch to Nyquil Cold/Flu at bedtime, another 1,000 mg.

Maybe you already use arthritis-strength acetaminophen for sore joints — average dose 1,300 mg.

Depending on how often they're taken, the total acetaminophen can add up fast.

That's the nonprescription realm. Surprisingly, 63 percent of unintentional overdoses involved narcotics like Vicodin and Percocet that contain from 325 mg to 750 mg of acetaminophen inside each pill.

Some were chronic pain sufferers taking more and more narcotics as their bodies adjusted to the powerful painkillers, not knowing they were getting ever-higher acetaminophen at the same time. Or they added over-the-counter products for other complaints.

Just this month, Larson treated an 18-year-old whose liver crashed after using Vicodin for three or four days for car-crash injuries. "She was just taking too much because her pain was bothering her."

Led by Tylenol manufacturer McNeil Consumer & Specialty Pharmaceuticals, most over-the-counter products now voluntarily list acetaminophen on front labels.

McNeil also runs ads about the risk, saying "if you're not going to read the label, then don't buy our products," says spokeswoman Kathy Fallon.

But how strongly labels warn varies by product. A rule to standardize warnings, urged by FDA's scientific advisers in 2002, still is working its way through the agency.

While FDA runs a consumer education campaign about the liver risk, nonprescription drugs chief Dr. Charles Ganley says the new study suggests the agency may need to further target narcotic-acetaminophen combinations.

Lee wants to copy Britain, which saw a 30 percent drop in severe liver poisonings after restricting how much acetaminophen could be bought at once.

That's unlikely. Meanwhile, the advice is simple: Read drug labels and add up all your acetaminophen, avoiding more 4,000 mg a day. For extra safety, Lee advises no more than 2,000 to 3,000 mg for more vulnerable people, who regularly use alcohol or have hepatitis.

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Keep your food safe - the raw and the cooked

Eating undercooked beef, especially hamburger, can increase your risk of infection with Escherichia coli (E. coli) bacteria. E. coli are a broad group of bacteria that live in the intestinal tract of healthy people and animals. Most of the bacteria are harmless and play an essential role in absorbing certain vitamins. But a few strains of E. coli are responsible for serious food-borne infections.
A particularly virulent strain of E.coli, called E. coli O157:H7,can cause severe, bloody diarrhea, kidney failure and even death. Most cases of E. coli O157:H7 have been traced to undercooked ground meat. Although it's not always possible to prevent food poisoning, knowing how E. coli spreads and how to handle food safely can help you avoid getting sick.


Dissecting the bad bugs



Not all disease-causing E. coli bacteria are created equal. One strain, enterotoxigenic E.coli, is a leading cause of diarrhea in children in developing nations. It's also responsible for most cases of traveler's diarrhea and is an increasing source of food-borne infection in industrialized countries.
Enterotoxigenic E.coli bacteria spread in contaminated food — including raw fruits and vegetables, raw seafood, and unpasteurized dairy products — and in contaminated water. Signs and symptoms, which include watery diarrhea and abdominal cramping, usually last just a few days. The infection normally clears on its own without treatment, and most adults and children have no lasting ill effects.
But E. coli O157:H7 is different. It produces a toxin that damages the lining of the small intestine, leading to intense abdominal cramps and severe, bloody diarrhea. You may have 10 or more bowel movements a day, some consisting almost entirely of blood. The marked loss of fluids and electrolytes causes dehydration and fatigue.
Nevertheless, many people recover completely from the infection in five to 10 days. But others, especially older adults, children under the age of 5 and people with weakened immune systems, may develop a serious complication called hemolytic uremic syndrome. This syndrome damages the lining of the tiny blood vessels in the kidneys, sometimes leading to kidney failure.
Even with the best of care, including blood and platelet transfusions and kidney dialysis, a few children die every year of hemolytic uremic syndrome. Others may have lifelong kidney problems or require long-term dialysis. Still others develop further complications such as high blood pressure, seizures, blindness and paralysis.


How E. coli spreads



You develop an E. coli infection when you accidentally ingest the bacteria. These are the most common sources of infection:
Contaminated food. E. coli bacteria exist naturally in the intestine of many animals, including cattle. Meat can become contaminated with fecal matter containing the bacteria when cattle are slaughtered or processed. The problem is particularly serious in modern feedlots, where animals spend their lives in crowded, filthy conditions. Although beef in general may be contaminated, ground meat is a special concern because grinding combines meat from different animals and transfers bacteria from the meat's surface to its interior. The bacteria also can spread from one surface to another, which means that bacteria on a cow's udder or on equipment can end up in milk. Pasteurization kills the bacteria, but raw milk can be a source of infection. Other foods that may become contaminated with the bacteria include dry cured sausage, salami, alfalfa sprouts, lettuce, and unpasteurized apple juice and apple cider.
Contaminated water. Runoff from feedlots can contaminate ground and surface water, including water used to irrigate crops. Drinking or inadvertently swallowing untreated water from lakes and streams can cause infection. So can eating unwashed raw fruits and vegetables. And although public water systems use chlorine, ultraviolet light or ozone to kill E. coli, some outbreaks have been linked to contaminated municipal water supplies. Private wells are a greater cause for concern. If you have a private well, have it tested once a year for pathogens, including E. coli. Your state health department can help you find a laboratory certified to conduct the tests.
Person-to-person contact. E. coli bacteria can easily travel from person to person, especially when infected adults and children don't wash their hands properly. Family members of young children with the infection are especially likely to become sick themselves. Children can shed the bacteria in their stools for up to two weeks after symptoms improve.
Keeping E. coli at bay



It's not always possible to avoid food poisoning, but common-sense precautions can go a long way toward preventing infection with E. coli O157:H7 bacteria.
Cook all ground meat, hamburger or roast beef thoroughly. Meat, especially if grilled, is likely to brown before it's completely cooked, so use a meat thermometer to ensure that meat is heated to at least 160 F at its thickest point. If you don't have a thermometer, cook ground meat until no pink shows in the center.
To prevent the growth of bacteria in your kitchen, thoroughly wash anything that comes in contact with raw meat, including your hands, counters and utensils. Use hot, soapy water, bleach or disinfecting wipes. Never put cooked hamburgers on the same plate you used for raw patties.
Order beef cooked medium or well-done when eating out. Be persistent about getting what you ask for, even if it means sending your food back more than once.
Drink pasteurized milk, juice and cider. Any boxed or bottled juice kept at room temperature is likely to be pasteurized, even if the label doesn't say so.
Wash raw produce thoroughly, using plenty of running water and a scrub brush or a vegetable wash. Children, older adults and people with weakened immune systems should avoid alfalfa sprouts.
Avoid drinking untreated water from lakes and streams and swallowing water when swimming — even pool water, which can be contaminated with feces.
Make sure that family members, including children, wash their hands after using the bathroom, changing diapers and before eating.
You're sick: Now what?



Most E. coli infections — even those caused by E. coli O157:H7 — aren't life-threatening. But the bacteria can cause serious and even fatal illness in some people. If you're at high risk of hemolytic uremic syndrome, see your doctor at the first sign of profuse or bloody diarrhea. If you're not at risk, seek medical advice if your symptoms are severe or persistent. You should have your stool checked for E. coli bacteria.
Most cases of traveler's diarrhea clear up on their own in a few days, although doctors sometimes prescribe a short course of the antibiotic rifaximin (Xifaxan), which reduces the number of E. coli bacteria in the gut. When it comes to more severe infections such as O157:H7, however, no current treatments can cure the infection, relieve symptoms or prevent complications.
Anti-diarrheals can make O157:H7 worse by preventing your body from eliminating the toxins. And antibiotics increase the risk of hemolytic uremic poisoning. For most people with O157:H7 infection, rest and plenty of fluids to prevent dehydration are the best option.