Acetaminophen OD More Deadly if Taken in Stages

Those who ingested more than 4,000 mg of acetaminophen in a single day spread out over more than one time point had a significantly higher mortality rate compared with those who overdosed at a single time point (37.3% versus 27.8%, P=0.025), according to Kenneth Simpson, MD, of the University of Edinburgh in Scotland, and colleagues.

The cohort analysis included 663 patients admitted with acetaminophen-induced severe liver injury from November 1992 through October 2008. About one-quarter (24.3%) overdosed in a staggered fashion, defined as taking at least two excessive doses separated by more than eight hours and adding up to more than 4,000 milligrams in one day. The rest of the patients ingested that much at a single time point.

Most of the patients who had a staggered overdose (58.2%) said that pain relief was the reason they repeatedly took an excessive dose. Another 34.3% said it was a suicide attempt.

via Medical News: Acetaminophen OD More Deadly if Taken in Stages – in Pain Management, Pain Management from MedPage Today.

Learn more at Acetaminophen Toxicity.

Personally I rarely take the stuff.  It’s pure poison for the liver.

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Bob MacDonald on What’s So Hard about Doing the Right Thing?

In the abstract it is easy to say that doing the right thing is – at the very least – reporting the improper activity. But what if your report seems to be ignored? Are you off the hook and have no further responsibility? Even worse, if you do report it and your boss survives with nothing more than a reprimand, what might this do to your personal well-being and your future with the company? In theory, of course, you could quit your job and find another; but in this economy, is that possible? Is now the right time to put you and your family’s financial future at risk? You could go halfway and say nothing while you look for another job, but is that the right thing to do?  This type of enigma is not an academic exercise. Anyone who has ever been in the business world, with ambitions to be successful and rise up the pyramid and support a family knows this type situation – and a wide variety of others – is more reality than theory. The real questions are: At what point are you willing to dilute or even trade in “doing the right thing,” to protect your career by “going along to get along”? At what point do you break and become willing to rationalize the elements of “doing the right thing?”

via What’s So Hard about Doing the Right Thing?.

Bob’s right.  Read his entire blog post to understand why it is not easy to do the right thing.  Thanks Bob and please keep writing and sharing.

Prostate-Cancer Screening — What the U.S. Preventive Services Task Force Left Out — NEJM

These approaches to managing serial PSA levels reflect either a fundamental misunderstanding of — or an unwillingness to acknowledge — PSA’s limitations as a marker for early prostate cancer. Observational studies show clearly that PSA levels fluctuate spontaneously, moving above or below whatever threshold clinicians deem worrisome. In addition, random biopsies can detect prostate cancer in 12% of men with PSA levels below 2 ng per milliliter and in 25% of men with levels between 2.1 and 4.0 ng per milliliter4; the latter figure approximates the prevalence often reported for men with levels between 4.0 and 10.0 ng per milliliter. When the PSA goes up — for example, from 3.0 to 4.0 ng per milliliter — and triggers a biopsy that reveals cancer, clinicians refer to “PSA-detected cancer.” But many of these cancers are not really detected by PSA screening; they are incidental findings against a background of randomly fluctuating PSA levels and an age-related increase in prostate-cancer incidence.

via Prostate-Cancer Screening — What the U.S. Preventive Services Task Force Left Out — NEJM.

Stratifying Risk — The U.S. Preventive Services Task Force and Prostate-Cancer Screening — NEJM.

I realize today is the day after Thanksgiving and I’m working.  But medicine never stops and a life underwriter has to do what a life underwriter does on her day off.  Read medical journals!  Check out these articles from NEJM.  Time to change our PSA underwriting guidelines?  I think so.  Call me if you need help with this.  I have a mortgage, one undergraduate, and one medical student to support.

Speaking of the medical student I was trapped this Thanksgiving in the car and listened to over five hours of lectures on neurology and hematology during the ride.  To tell the truth, I enjoyed the lectures.

Medicine never takes a day off nor do expert life underwriters.