SEARCH CONTENTS

Custom Search

Abdominal ultrasound > Acetone poisoning | Medical Encyclopedia

ADS


Medical Encyclopedia


1. Abdominal ultrasound
2. Abdominal wall fat pad biopsy
3. Abdominal wall surgery
4. Abdominal x-ray
5. ABO incompatibility
6. Abortion - medical
7. Abortion - surgical
8. Abortion - surgical - aftercare
9. Abscess
10. Abscess - abdomen or pelvis
11. Abscess scan - radioactive
12. Absence seizure
13. Absent pulmonary valve
14. Acanthosis nigricans
15. ACE blood test
16. ACE inhibitors
17. Acetaminophen and codeine overdose
18. Acetaminophen dosing for children
19. Acetaminophen overdose
20. Acetone poisoning


Abdominal ultrasound

Abdominal ultrasound is an type of imaging test. It is used to examine organs in the abdomen including the liver, gallbladder, spleen, pancreas, and kidneys. The blood vessels that lead to some of these organs can also be looked at with ultrasound.

How the Test is Performed

An ultrasound machine makes images of organs and structures inside the body. The machine sends out high-frequency sound waves that reflect off body structures. A computer receives these waves and uses them to create a picture. Unlike with x-rays or CT scans, this test does not expose you to ionizing radiation.
You will be lying down for the procedure. A clear, water-based conducting gel is applied to the skin over the abdomen. This helps with the transmission of the sound waves. A handheld probe called a transducer is then moved over the abdomen.
You may need to change position so that the health care provider can look at different areas. You may also need to hold your breath for short periods during the exam.
Most of the time, the test takes less than 30 minutes.

How to Prepare for the Test

Preparation steps vary depending on the problem. Most of the time, people are asked not to eat or drink for several hours before the exam. Your health care provider will go over what you need to do.

How the Test Will Feel

There is little discomfort. The conducting gel may feel a little cold and wet.

Why the Test is Performed

You may have this test to:
• Find the cause of abdominal pain
• Find the cause of kidney infections
• Diagnose a hernia
• Diagnose and monitor tumors and cancers
• Diagnose or treat ascites
• Learn why there is swelling of an abdominal organ
• Look for damage after an injury
• Look for stones in the gallbladder or kidney
• Look for the cause of abnormal blood tests such as liver function tests or kidney tests
• Look for the cause of a fever
The reason for the test will depend on your symptoms.

Normal Results

The organs examined appear normal.

What Abnormal Results Mean

The meaning of abnormal results depends on the organ being examined and the type of problem. Talk to your health care provider if you have any questions or concerns.
An abdominal ultrasound can indicate conditions such as:
• Abdominal aortic aneurysm
• Abscess
• Appendicitis
• Cholecystitis
• Gallstones
• Hydronephrosis
• Kidney stones
• Pancreatitis (inflammation in pancreas)
• Spleen enlargement (splenomegaly)

Risks

There is no known risk. You are not exposed to ionizing radiation.

Alternative Names

Ultrasound - abdomen; Abdominal sonogram

References

Cosgrove DO, Meire HB, Lim A, Eckersley RJ. Ultrasound: general principles. In: Adam A, Dixon AK, eds.Grainger & Allisonn's Diagnostic Radiology: A Textbook of Medical Imaging
Kim DH, Pickhardt PJ. Diagnostic imaging procedures in gastroenterology. In: Goldman L, Ausiello D, eds.Cecil Medicine

Abdominal wall fat pad biopsy

An abdominal wall fat pad biopsy is the removal of a small part of the abdominal wall fat pad. The procedure is done most often to test for amyloidosis.

How the Test is Performed

Needle aspiration is the most common method of taking an abdominal wall fat pad biopsy.
The health care provider cleans the skin on your belly area. Numbing medicine may be applied on the area. A needle is placed through the skin and into the fat pad under the skin. A small piece of the fat pad is removed with the needle. It is sent to a laboratory for analysis.

How to Prepare for the Test

No special preparation is usually necessary.

How the Test Will Feel

You may have some mild discomfort or feel pressure when the needle is inserted. Afterward, the area may feel tender or be bruised for several days.

Why the Test is Performed

This test may be performed when amyloidosis is suspected.

Normal Results

The fat pad tissues are normal.

What Abnormal Results Mean

In the case of amyloidosis, abnormal results mean there is amyloid, a protein that deposits in tissues and impairs organ and tissue function.

Risks

The risks are minimal. There is a slight risk of infection. There is also a minor risk of bruising or slight bleeding.

Alternative Names

Abdominal wall biopsy; Biopsy - abdominal wall fat pad

References

Gertz MA. Amyloidosis. In: Goldman L, Schafer AI, eds.Cecil Medicine

Abdominal wall surgery

Abdominal wall surgery is surgery that improves the appearance of flabby, stretched-out abdominal (belly) muscles and skin. It is often called a "tummy tuck." It can range from a simple "mini-tummy tuck" to more complicated, extensive surgery.
Abdominal wall surgery is not the same as liposuction, which is another way to remove fat. But abdominal wall surgery is sometimes combined with liposuction.

Description

Your surgery will be done in an operating room in a hospital. You will receive general anesthesia. This will make you sleep and keep you pain-free during the procedure. The surgery takes 2 to 6 hours. You can expect to stay in the hospital for 1 to 3 days after surgery.
After you receive anesthesia, your surgeon will make a cut across your abdomen to open up the area. This cut will be just above your pubic area.
Your surgeon will remove fatty tissue and loose skin from the middle and lower sections of your abdomen to make it firmer and flatter. In extended surgeries, the surgeon also removes excess fat and skin (love handles) from the sides of the abdomen. Your abdominal muscles may be tightened also.
Mini abdominoplasty is performed when there are areas of fat pockets (love handles). It can be done with much smaller cuts.
Your surgeon will close your cut with sutures (stitches). Your surgeon may insert small flat tubes called drains to allow fluid to drain out of your cut. These will be removed later.
A firm elastic dressing (bandage) will be placed over your abdomen.
For less complicated surgery, your surgeon may use a medical device called an endoscope. Endoscopes are tiny cameras that are inserted into the skin through very small cuts. They are connected to a video monitor in the operating room that allows the surgeon to see the area being worked on. Your surgeon will remove excess fat with other small tools that are inserted through other small cuts. This surgery is called endoscopic surgery.

Why the Procedure is Performed

Most of the time, the surgery is called elective or cosmetic surgery because it is an operation you choose to have. It is not usually needed for health reasons. Cosmetic abdomen repair can help improve appearance, especially after a lot of weight gain or loss. It helps flatten the lower abdomen and tighten stretched skin.
It may also help relieve skin rashes or infections that happen under large flaps of skin.
Abdominoplasty can be helpful when:
• Diet and exercise have not helped improve muscle tone, such as in women who have had more than one pregnancy.
• Skin and muscle cannot regain its normal tone. This can be a problem for very overweight people who lost a lot of weight.
Tummy tuck is major surgery. It is important to read about the procedure before having it.
Abdominoplasty is not used as an alternative to weight loss.

Risks

The risks for any anesthesia are:
• Reactions to medicines
• Breathing problems
• Heart attack or stroke
The risks for any surgery are:
• Bleeding
• Infection
• Bruising
• Swelling
• Scarring
• Blood clots in the legs or lungs
Risks of abdominoplasty are:
• Damage to internal organs
• Excessive scarring
• Having a very low body temperature during surgery
• Loss of skin
• Nerve damage that can cause pain or numbness in part of your belly
• Poor healing

Before the Procedure

Always tell your doctor or nurse:
• If you could be pregnant
• What drugs you are taking, even drugs, supplements, or herbs you bought without a prescription
Before your surgery:
• Several days before surgery, you may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), warfarin (Coumadin), and any other drugs that affect blood clotting.
• Ask your doctor which drugs you should still take on the day of your surgery.
• If you smoke, try to stop. Ask your doctor or nurse for help. You must stop smoking for at least 2 weeks before surgery. Smoking significantly increases the risk for complications.
On the day of your surgery:
• You will usually be asked not to drink or eat anything after midnight the night before your surgery.
• Take the drugs your doctor told you to take with a small sip of water.
• Your doctor or nurse will tell you when to arrive at the hospital.

After the Procedure

You will have some pain and discomfort for several days after surgery. Your doctor will prescribe pain medicine to help you manage your pain. It may help to rest with your legs and hips bent during recovery to reduce pressure on your abdomen.
Wearing an elastic support similar to a girdle for 2 to 3 weeks will provide extra support while you heal. You should avoid strenuous activity and anything that makes you strain for 4 to 6 weeks. You will probably be able to return to work in 2 to 4 weeks.
You will need to schedule a visit with your doctor to have your stitches removed.
Your scars will become flatter and lighter in color over the next 3 to 6 months. Do not expose the area to sun, because it can worsen the scar and darken the color. Keep it covered when you are out in the sun. You may have to apply a special cream until the cut is completely healed.

Outlook (Prognosis)

Most people are happy with the results of abdominoplasty. Many feel a new sense of self-confidence.

Alternative Names

Cosmetic surgery of the abdomen; Tummy tuck; Abdominoplasty

References

McGrath MH, Pomerantz J. Plastic surgery. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds.Sabiston Textbook of Surgery

Abdominal x-ray

An abdominal x-ray is an imaging test to look at organs and structures in the belly area. Organs include the spleen, stomach, and intestines.
When the test is done to look at the bladder and kidney structures, it is called a KUB (kidneys, ureters, bladder) x-ray.

How the Test is Performed

The test is done in a hospital radiology department. Or it may done in the health care provider's office by an x-ray technologist.
You lie on your back on the x-ray table. The x-ray machine is positioned over your abdominal area. You hold your breath as the picture is taken so that the picture will not be blurry. You may be asked to change position to the side or to stand up for additional pictures.

How to Prepare for the Test

Before having the x-ray, tell the health care provider the following:
• If you are pregnant or think you could be pregnant
• Have an IUD inserted
• Have had a barium contrast media x-ray in the last 4 days
• If you have taken any medicines such as Pepto Bismol in the last 4 days (this type of medicine can interfere with the x-ray)
You wear a hospital gown during the x-ray procedure. You must remove all jewelry. You must sign an informed consent form.

How the Test Will Feel

There is no discomfort. The x-rays are taken as you lie on your back, side, and while standing.

Why the Test is Performed

• Diagnose a pain in the abdomen or unexplained nausea
• Identify suspected problems in the urinary system, such as a kidney stone
• Identify blockage in the intestine
• Locate an object that has been swallowed

Normal Results

The x-ray will show normal structures for a person your age.

What Abnormal Results Mean

Abnormal findings include:
• Abdominal masses
• Buildup of fluid in the abdomen
• Certain types of gallstones
• Foreign object in the intestines
• Hole in the stomach or intestines
• Injury to the abdominal tissue
• Intestinal blockage
• Kidney stones
The test may be performed for:
• Abdominal aortic aneurysm
• Acute appendicitis
• Acute cholecystitis
• Acute kidney failure
• Addison disease
• Adenomyosis
• Annular pancreas
• Ascariasis
• Atheroembolic renal disease
• Biliary atresia
• Blind loop syndrome
• Cholangitis
• Chronic renal failure
• Cirrhosis
• Echinococcus
• Encopresis
• Hirschsprung disease
• Idiopathic aplastic anemia
• Injury of the kidney and ureter
• Intussusception (children)
• Necrotizing enterocolitis
• Nephrocalcinosis
• Peritonitis, spontaneous
• Primary or idiopathic intestinal pseudo-obstruction
• Renal artery stenosis
• Renal cell carcinoma
• Secondary aplastic anemia
• Toxic megacolon
• Wilms tumor

Risks

There is low radiation exposure. X-rays are monitored and regulated to provide the minimum amount of radiation exposure needed to produce the image. Most experts feel that the risk is low compared with the benefits.
Pregnant women and children are more sensitive to the risks of the x-ray. Women should tell the health care provider if they are, or may be, pregnant.

Considerations

The test is not usually recommended for pregnant women. The ovaries and uterus cannot be shielded during the abdominal x-ray because of their location.
Men should have a lead shield placed over the testes to protect against the radiation.

Alternative Names

Abdominal film; X-ray - abdomen; Flat plate; KUB x-ray

References

Morrison I. The plain abdominal radiograph and associated anatomy and techniques. In: Adam A, Dixon AK, eds.Grainger & Allison's Diagnostic Radiology: A Textbook of Medical Imaging.

ABO incompatibility

A, B, AB, and O are the four major blood types. The types are based on small substances (molecules) on the surface of the blood cells.
When people who have one blood type receive blood from someone with a different blood type, it may cause their immune system to react. This is called ABO incompatibility.

Causes

The different blood types are:
• Type A
• Type B
• Type AB
• Type O
People who have one blood type may form proteins (antibodies) that cause their immune system to react against one or more of the other blood types.
Being exposed to another type of blood can cause a reaction. This is important when a patient needs to receive blood (transfusion) or have an organ transplant. The blood types must be compatible to avoid an ABO incompatibility reaction.
For example:
• A patient with type A blood will react against type B or type AB blood.
• A patient with type B blood will react against type A or type AB blood.
• A patient with type O blood will react against type A, type B, or type AB blood.
• A patient with type AB blood will not react against type A, type B, type AB, or type O blood.
Type O blood does not cause an immune response when it is given to people with type A, type B, or type AB blood. This is why type O blood cells can be given to patients of any blood type. People with type O blood are called universal donors. But people with type O can only receive type O blood.
Both blood and plasma transfusions must be matched to avoid an immune reaction. Before anyone receives blood, both the blood and the person receiving it are tested carefully to avoid a reaction. Usually a reaction occurs because of a clerical error causing a patient to receive incompatible blood.

Symptoms

The following are symptoms of ABO incompatible transfusion reactions:
• Back pain
• Blood in urine
• Chills
• Feeling of "impending doom"
• Fever
• Yellow skin (jaundice)

Exams and Tests

The health care provider will perform a physical exam. Blood tests will usually show:
• Bilirubin level is high
• Complete blood count (CBC) shows damage to red blood cells or anemia
• The patient's and donor's blood are not compatible
Urine tests show the presence of hemoglobin due to breakdown of red blood cells.

Treatment

Treatment may include:
• Drugs used to treat allergic reactions (antihistamines)
• Drugs used to treat swelling and allergies (steroids)
• Fluids given through a vein (intravenously)
• Medicines to raise blood pressure if it drops too low

Outlook (Prognosis)

ABO incompatibility can be a very serious problem that can result in death. With the right treatment, a full recovery is expected.

Possible Complications

• Kidney failure
• Low blood pressure needing intensive care
• Death

When to Contact a Medical Professional

Call your health care provider if you have recently had a blood transfusion or transplant and you have symptoms of ABO incompatibility.

Prevention

Careful testing of donor and patient blood types before transfusion or transplant can prevent this problem.

References

Goodnough L. Transfusion medicine. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine

Abortion - medical

Medical abortion is the use of medicine to end a pregnancy. The medicine helps remove the fetus and placenta from the mother's womb (uterus).
There are different types of medical abortions.
• Therapeutic medical abortion is done because the woman has a health condition.
• Elective abortion is done because a woman chooses (elects) to end the pregnancy.
An abortion is not the same as a miscarriage. Miscarriage is when a pregnancy ends on its own before the 20th week.
Surgical abortion uses surgery to end a pregnancy.

Description

A medical, or nonsurgical, abortion can be done within 7 weeks from the first day of the woman's last period. A combination of prescription hormone medicines are used to help the body remove the fetus and placenta tissue. The doctor may give you the medicines after performing a physical exam and asking questions about your medical history.
Medicines used include mifepristone, methotrexate, misoprostol, prostaglandins, or a combination of these medicines.

Why the Procedure is Performed

Medical abortion might be considered when:
• The developing baby has a birth defect or genetic problem
• The pregnancy is harmful to the woman's health (therapeutic abortion)
• The pregnancy resulted after a traumatic event such as rape or incest
• The woman may not wish to be pregnant (elective abortion)

Risks

Risks of medical (nonsurgical) abortion include:
• Continued bleeding
• Diarrhea
• Pregnancy tissue not passing completely from body, making surgery necessary
• Infection
• Nausea
• Pain
• Vomiting

Before the Procedure

The decision to end a pregnancy is very personal. To help weigh your choices, discuss your feelings with a counselor, health care provider, or a family member or friend.
Test done before this procedure:
• Pelvic examination is done to confirm the pregnancy and estimate how many weeks pregnant you are.
• HCG blood test may be done to confirm the pregnancy.
• Vaginal or abdominal ultrasound may be done to determine the exact age of the fetus and its location in the womb.

After the Procedure

Physical recovery usually occurs within a few days, depending on the stage of the pregnancy. Expect some vaginal bleeding and mild cramping for a few days.
A warm bath, a heating pad set on low, or hot water bottle filled with warm water on the abdomen may help relieve discomfort. Rest as needed. Do not do any vigorous activity for a few days. Light housework is fine. Sexual intercourse should be avoided for 2-3 weeks. A normal menstrual period should occur in about 4-6 weeks.
You can get pregnant before your next period. Be sure to make arrangements to prevent pregnancy, especially during the first month after the abortion.

Outlook (Prognosis)

Complications (problems) rarely occur.

Alternative Names

Therapeutic medical abortion; Elective medical abortion; Induced abortion; Nonsurgical abortion

References

American College of Obstetricians and Gynecologists. Clinical management guidelines of obstetrician-gynecologists. Medical management of abortion.Obstet Gynecol
Annas GJ, Elias S. Legal and ethical issues in obstetric practice. In: Gabbe SG, Niebyl JR, Simpson JL, eds.Obstetrics: Normal and Problem Pregnancies
Jensen JT, Mishell Jr DR. Family planning: contraception, sterilization, and pregnancy termination. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds.Comprehensive Gynecology
Simpson JL, Jauniaux ERM. Pregnancy loss. In: Gabbe SG, Niebyl JR, Simpson JL, eds.Obstetrics: Normal and Problem Pregnancies

Abortion - surgical

Surgical abortion is a procedure that ends a pregnancy by removing the fetus and placenta from the mother's womb (uterus).
Surgical abortion is not the same as miscarriage. Miscarriage is when a pregnancy ends on its own before the 20th week.

Description

Surgical abortion uses a vacuum to remove the fetus and related pregnancy material from the uterus. The procedure is most often done 6 weeks after the woman's last menstrual period or soon afterward when possible.
Before the procedure, you may have the following tests:
• A urine test checks if you are pregnant.
• A blood test checks your blood type. Based on the test result, you may need a special shot to prevent problems if you get pregnant in the future. The shot is called Rhogam.
• An ultrasound test checks how many weeks you are pregnant.
During the procedure:
• You lie on an exam table.
• You may receive medicine (sedative) to help you relax and feel sleepy.
• Your feet will rest in supports called stirrups. These allow your legs to be positioned so that the doctor can view the vagina and cervix.
• The doctor may numb the cervix so you feel little pain during the procedure.
• Small rods called dilators will be put in the cervix to gently stretch it open. Sometimes laminaria, or sticks of seaweed for medical use, are placed in the cervix. This is done the day before the procedure to help the cervix dilate slowly.
• The doctor inserts a tube into the womb and the vacuum is used to remove the pregnancy tissues.
After the procedure, you may be given medicine to help the uterus contract. This reduces bleeding.

Why the Procedure is Performed

Reasons a surgical abortion might be considered include:
• Your baby has a birth defect or genetic problem.
• Your pregnancy is harmful to your health (therapeutic abortion).
• The pregnancy resulted after a traumatic event such as rape or incest.
The decision to end a pregnancy is very personal. To help you weigh your choices, discuss your feelings with a counselor or health care provider. A family member or friend can also be of help.

Risks

Risks of surgical abortion include:
• Damage to the womb or cervix
• Uterine perforation (accidentally putting a hole in the uterus with one of the instruments used)
• Excessive bleeding
• Infection of the uterus or fallopian tubes
• Scarring of the inside of the uterus
• Reaction to the medicines or anesthesia, such as problems breathing
• Not removing all of the tissue, with the need for another procedure

After the Procedure

You will stay in a recovery area for a few hours. The health care providers will tell you when you can go home. Because you may still be drowsy from the medicines, arrange ahead of time to have someone pick you up.
Follow instructions for how to care for yourself at home. Make any follow-up appointments.

Outlook (Prognosis)

Complications (problems) rarely occur after this procedure.
Physical recovery usually occurs within a few days, depending on the stage of the pregnancy. Vaginal bleeding can last for a week to 10 days. Cramping usually lasts for a day or two.
You can get pregnant before your next period, which occurs 4-6 weeks after the procedure. Be sure to make arrangements to prevent pregnancy, especially during the first month after the procedure. You may want to talk with your health care provider about emergency contraception.

Alternative Names

Suction curettage; Surgical abortion; Elective abortion - surgical; Therapeutic abortion - surgical

References

Annas GJ, Elias S. Legal and ethical issues in obstetric practice. In: Gabbe SG, Niebyl JR, Simpson JL, eds.Obstetrics: Normal and Problem Pregnancies
Jensen JT, Mischell Jr DR. Family planning: contraception, sterilization, and pregnancy termination. In: Katz VL, Lentz GM, Lobo RA, Katz VL, eds.Comprehensive Gynecology

Abortion - surgical - aftercare

You have had a surgical abortion. This is a procedure that ends pregnancy by removing the fetus and placenta from your womb (uterus).

What to Expect

You will likely recover without problems. It may take a few days to feel well.
You may have cramps that feel like menstrual cramps for a few days.
Your normal period will likely return in 4 to 6 weeks.
It is normal to feel sad or depressed after this procedure. Seek help from your health care provider or a counselor if these feelings do not go away. A family member or friend can also provide comfort.

Self-care

To relieve discomfort or pain in your abdomen:
• Take a warm bath.
• Apply a heating pad to your lower abdomen or place a hot water bottle filled with warm water on your abdomen.
• Take over-the-counter painkillers as instructed.
Follow these activity guidelines after your procedure:
• Rest as needed.
• DO NOT do any strenuous activity the first few days. This includes not lifting anything heavier than 10 pounds (about the weight of a 1-gallon milk jug).
• Also, DO NOT do any aerobic activity, including running or working out. Light housework is fine.
Other things to help speed your recovery include:
• Use pads to absorb bleeding and drainage from your vagina. Change the pads every 2 to 4 hours to avoid infection.
• DO NOT use tampons or put anything in your vagina, including douching.
• DO NOT have vaginal intercourse for 2 to 3 weeks, or until cleared by your health care provider.
• Take any other medicine, such as an antibiotic, as instructed.
• Begin using birth control right after your procedure. It is possible to get pregnant again even before your normal period resumes. Birth control can help prevent unplanned pregnancies. Be aware though, unplanned pregnancies can occur even when you use birth control.

Contact Your Health Care Provider If:

• You have vaginal bleeding that increases or you need to change your pads more often than every 2 to 4 hours.
• You have continued pain or pregnancy symptoms.
• You have signs of infection, including fever that does not go away, vaginal drainage with a foul odor, vaginal drainage that looks like pus, or pain or tenderness in your abdomen.

References

Jensen JT, Mishell Jr. DR. Family planning: contraception, sterilization, and pregnancy termination. In: Lentz GM, Lobo RA, Gershenson DM, Katz VL, eds. Comprehensive Gynecology.


Abscess

An abscess is a collection of pus in any part of the body that, in most cases, causes swelling and inflammation around it.

Causes

Abscesses occur when an area of tissue becomes infected and the body's immune system tries to fight it. White blood cells move through the walls of the blood vessels into the area of the infection and collect in the damaged tissue. During this process, pus forms. Pus is the buildup of fluid, living and dead white blood cells, dead tissue, and bacteria or other foreign substances.
Abscesses can form in almost any part of the body. The skin, under the skin, and the teeth are the most common sites. Abscesses may be caused by bacteria, parasites, and foreign substances.
Abscesses in the skin are easy to see. They are red, raised, and painful. Abscesses in other areas of the body may not be seen, but they may cause organ damage.
Types of abscesses include:
• Abdominal abscess
• Amebic liver abscess
• Anorectal abscess
• Bartholin abscess
• Brain abscess
• Epidural abscess
• Peritonsillar abscess
• Pyogenic liver abscess
• Skin abscess
• Spinal cord abscess
• Subcutaneous abscess
• Tooth abscess

Exams and Tests

Often, a sample of fluid will be taken from the abscess and tested to see what type of germ is causing the problem.

Treatment

Treatment varies, but often surgery to drain the abscess, antibiotics, or both are needed.

When to Contact a Medical Professional

Call your health care provider if you think that you have any type of abscess.

Prevention

Preventing abscesses depends on where they develop. For example, good hygiene can help prevent skin abscesses. Dental hygiene and routine care will prevent tooth abscesses.

References

Holtzman LC, Hitti E, Harrow J. Incision and drainage. In: Roberts JR, Hedges JR, eds.Clinical Procedures in Emergency Medicine

Abscess - abdomen or pelvis

An abdominal abscess is a pocket of infected fluid and pus located inside the belly (abdominal cavity). This type of abscess can be located near or inside the liver, pancreas, kidneys or other organs. There can be one or more abscesses.

Causes

You can get abdominal abscesses because you have:
• A burst appendix
• A burst intestine
• A burst ovary
• Inflammatory bowel disease
• Infection in your gallbladder, pancreas, ovary or other organs
• Pelvic infection
• Parasite infection
You are more at risk for an abdominal abscess if you have:
• Trauma
• Perforated ulcer disease
• Surgery in your belly area
• Weakened immune system
Germs may pass through your blood to an organ in your belly. Sometimes, no reason can be found for an abscess.

Symptoms

Pain or discomfort in the belly that does not go away is a common symptom. This pain:
• May be found only in one area of your belly or over most of your belly
• May be sharp or dull
• May become worse over time
Depending on where the abscess is located, you may have:
• Pain in your back
• Pain in your chest or shoulder
Other symptoms of an abdominal abscess may be a lot like symptoms of having the flu. You may have:
• Swollen belly
• Diarrhea
• Fever or chills
• Lack of appetite and possible weight loss
• Nausea or vomiting
• Weakness
• Cough

Exams and Tests

Your symptoms can be a sign of many different problems. Your health care provider will do some tests when they think you have an abdominal abscess. These may include the following tests:
• Complete blood count -- A high white blood cell count is a possible sign of an abscess of other infection.
• Comprehensive metabolic panel -- This will show any liver, kidney or blood problems.
Other tests that should show abdominal abscesses:
• Abdominal x-ray
• Ultrasound of the abdomen and pelvis
• CT scan of the abdomen and pelvis
• MRI of the abdomen and pelvis

Treatment

Your health care team will try to identify and treat the cause of the abscess. Your abscess will be treated with antibiotics and drainage of the pus. At first, you will likely receive care in the hospital.
ANTIBIOTICS
You will be given antibiotics to treat the abscess. You will take them for up to 4 to 6 weeks.
• You will start on IV antibiotics in the hospital and you may receive IV antibiotics at home.
• You then may change to pills. Be sure you take all of your antibiotics, even if you feel better.
DRAINAGE
Your abscess needs to be drained of pus. Your health care provider and you will decide the best way to do this.
Using a needle and drain -- Your provider puts a needle through the skin and into the abscess. Usually, this is done with the help of x-rays to make sure the needle is inserted into the abscess.
Your provider will give you medicine to make you sleepy, and medicine to numb the skin before the needle is inserted into the skin.
A sample of the abscess will be sent to the lab. This helps your provider choose which antibiotics to use.
A drain is left in the abscess so that pus can drain out. Usually, the drain is kept in for days or weeks until the abscess gets better.
Having surgery -- Sometimes a surgeon does surgery to clean out the abscess. You will be put under general anesthesia so that you are asleep for the surgery. Surgery may be needed if:
• Your abscess cannot be reached safely using a needle through the skin
• Your appendix, intestines, or another organ has burst
The surgeon will make a cut into the belly area. Laparotomy involves a larger cut. Laparoscopy uses a very small cut and a laparascope (a tiny video camera). The surgeon will then:
• Clean and drain the abscess.
• Put a drain into the abscess. The drain stays in until the abscess gets better.

Outlook (Prognosis)

How well you respond to treatment depends on the cause of the abscess and how bad the infection is. It also depends on your overall health. Usually antibiotics and drainage takes care of abdominal abscesses that have not spread.
You may need more than one operation. Sometimes, an abscess will come back.

Possible Complications

Complications may include:
• The abscess may not drain fully
• The abscess may come back (recur)
• The abscess may cause severe illness and a bloodstream infection
• The infection could spread

When to Contact a Medical Professional

Call your health care provider if you have:
• Severe abdominal pain
• Fevers
• Nausea
• Vomiting
• Changes in bowel habits

Alternative Names

Abscess - intra-abdominal; Pelvic abscess

References

Minei JP, Champine JG. Abdominal abscesses and gastrointestinal fistulas. In: Feldman M, Friedman LS, Brandt LJ, eds.Sleisenger and Fordtran's Gastrointestinal and Liver Disease.
Prather C. Inflammatory and anatomic diseases of the intestine, peritoneum, mesentery, and omentum. In: Goldman L, Schafer AI, eds.Goldman's Cecil Medicine.
Squires RA, Postier RG. Acute abdomen. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds.Sabiston Textbook of Surgery.

Abscess scan - radioactive

Radioactive abscess scan looks abscesses in the body using a radioactive material. An abscess occurs when pus collects due to an infection.

How the Test is Performed

Blood is drawn from a vein, most often on the inside of the elbow or the back of the hand.
• The site is cleaned with germ-killing medicine (antiseptic).
• The health care provider wraps an elastic band around the upper arm to apply pressure to the area and make the vein swell with blood.
• Next, the health care provider gently inserts a needle into the vein. The blood collects into an airtight vial or tube attached to the needle.
• The elastic band is removed from your arm.
• The puncture site is covered to stop any bleeding.
The blood sample is then sent to a lab. There the white blood cells are tagged with a radioactive substance called indium. The cells are then injected back into a vein body through another needle stick.
You will need to return to the office 6-24 hours later. At that time, you will have a nuclear medicine scan to see if white blood cells have gathered in areas of your body where they would not be normally.

How to Prepare for the Test

Most of the time you do not need special preparation. You will need to sign a consent form.
For the test, you will need to wear a hospital gown or loose clothing. You will need to take off all jewelry.
Tell the health care provider if you are pregnant. This procedure is NOT recommended if you are pregnant or trying to become pregnant. Women of childbearing age (before menopause) should use some form of birth control during the course of this procedure.
Tell your health care provider if you have or had any of the following medical conditions, procedures, or treatments, as they can interfere with test results:
• Gallium (Ga) scan within the past month
• Hemodialysis
• Hyperglycemia
• Long-term antibiotic therapy
• Steroid therapy
• Total parenteral nutrition (through an IV)

How the Test Will Feel

Some people feel a little pain when the needle is inserted to draw blood. Others feel only a prick or sting. Afterward, there may be some throbbing.
The nuclear medicine scan is painless. It may be a little uncomfortable to lie flat and still on the scanning table. This is only for a short time.

Why the Test is Performed

An abscess may form after surgery, or it may form on its own. Symptoms of an abscess depend on where it is found, but may include:
• Fever
• Not feeling well (malaise)
• Pain
This test is used to locate an abscess in the body. Often, other imaging tests such as an ultrasound or CT scan may be done first.

Normal Results

Normal findings would show no abnormal gathering of white blood cells.

What Abnormal Results Mean

A gathering of white blood cells outside of the normal areas is a sign of either an abscess or other type of inflammatory process.
Some types of abscess are:
• Abdominal abscess
• Amebic liver abscess
• Anorectal abscess
• Bartholin's abscess
• Epidural abscess
• Peritonsillar abscess
• Pyogenic liver abscess
• Skin abscess
• Spinal cord abscess
• Subcutaneous abscess
• Tooth abscess

Risks

• Some bruising may occur at the site of injection.
• There is always a slight chance of infection when the skin is broken.
• There is low-level radiation exposure.
The test is controlled so that you get only the smallest amount of radiation exposure needed to produce the image. Most experts feel that the risk is very low compared with the benefits.
Pregnant women and children are more sensitive to the risks of the x-ray.

Alternative Names

Radioactive abscess scan; Abscess scan

References

Segerman D, Miles KA. Radionuclide imaging: general principles. In: Adam A, Dixon AK, eds.Grainger & Allison's Diagnostic Radiology: A Textbook of Medical Imaging
Wilson DJ, Berendt AR. Bone and soft tissue infection. In: Adam A, Dixon AK, eds.Grainger & Allison's Diagnostic Radiology: A Textbook of Medical Imaging

Absence seizure

An absence seizure is the term given to a staring spell. This type of seizure is a brief (usually less than 15 seconds) disturbance of brain function due to abnormal electrical activity in the brain.

Causes

Absence seizure occur most often in people under age 20, usually in children ages 6 to 12.
They may occur with other types of seizures, such as generalized tonic-clonic seizures (grand mal seizures), twitches or jerks (myoclonus), or sudden loss of muscle strength (atonic seizures).

Symptoms

Most absence seizures last only a few seconds. They often involve staring episodes. The episodes may:
• Occur many times a day
• Occur for weeks to months before being noticed
• Interfere with school and learning
• Be mistaken for lack of attention or other misbehavior
Unexplained difficulties in school and learning difficulties may be the first sign of absence seizures.
During the seizure, the person may:
• Stop walking and start again a few seconds later
• Stop talking in mid-sentence and start again a few seconds later
The person usually does not fall during the seizure.
Immediately after the seizure, the person is usually:
• Wide awake
• Thinking clearly
• Unaware of the seizure
Specific symptoms of typical absence seizures may include:
• Changes in muscle activity, such as no movement, hand fumbling, fluttering eyelids, lip smacking, chewing
• Changes in alertness (consciousness), such as staring episodes, lack of awareness of surroundings, sudden halt in movement, talking, and other awake activities
• May be triggered by hyperventilation or flashing lights, in some cases
Some absence seizures begin slower and last longer. These are called atypical absence seizures. Symptoms are similar to regular absence seizures, but muscle activity changes may be more noticeable.

Treatment

For information on diagnosis and treatment, see:
• Epilepsy
• Seizures

Alternative Names

Seizure - petit mal; Seizure - absence; Petit mal seizure; Epilepsy - absence seizure

References

Abou-Khalil BW, Gallagher MJ, Macdonald RL. Epilepsies. In: Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC, eds.Bradley's Neurology in Clinical Practice.
Buchhalter J. Treatment of childhood absence epilepsy -- an evidence-based answer at last! Epilepsy Curr
Wiebe S. The epilepsies. In: Goldman L, Schafer AI, eds.Goldman's Cecil Medicine

Absent pulmonary valve

Absent pulmonary valve is a rare defect in which the pulmonary valve, through which oxygen-poor blood flows from the heart to the lungs (where it picks up oxygen) is either missing or poorly formed. This condition is present at birth (congenital).

Causes

Absent pulmonary valve occurs when the pulmonary valve does not form or develop properly while the baby is in the mother's womb. When present, it often occurs as part of a heart condition called tetralogy of Fallot.
When the pulmonary valve is missing or does not work well, not enough blood can flow efficiently to the lungs to get oxygen.
There is also usually a hole between the left and right ventricles of the heart (ventricular septal defect). This defect will also lead to low-oxygen blood being pumped out to the body.
The skin will have a blue appearance (cyanosis), because the body's blood contains a low amount of oxygen.
Absent pulmonary valve also results in very enlarged (dilated) branch pulmonary arteries (the arteries that carry blood to the lungs). They can become so enlarged that they press on the tubes that bring air to the lungs (bronchi) and cause breathing problems.
Other heart defects that can occur with absent pulmonary valve include:
• Abnormal tricuspid valve
• Atrial septal defect
• Double outlet right ventricle
• Ductus arteriosis
• Endocardial cushion defect
• Marfan syndrome
• Tricuspid atresia
Heart problems that occur with absent pulmonary valve may be due to defects of the genes (chromosomes).

Symptoms

Symptoms can vary depending on which other defects the infant has, but may include:
• Blue coloring to the skin (cyanosis)
• Coughing
• Failure to thrive
• Poor appetite
• Rapid breathing
• Respiratory failure
• Wheezing

Exams and Tests

Absent pulmonary valve may be diagnosed before the baby is born with a test that uses sound waves to create an image of the heart (echocardiogram).
During an examination, the doctor may hear a murmur in the infant's chest.
Tests for absent pulmonary valve include:
• A test to measure the electrical activity of the heart (electrocardiogram)
• Chest CT scan
• Chest x-ray
• Echocardiogram
• Magnetic resonance imaging (MRI) of the heart

Treatment

Infants who have breathing symptoms typically need immediate surgery. Infants without severe symptoms typically have surgery within the first 3 to 6 months of life.
Depending on the type of other heart defects the infant has, surgery may involve:
• Closing the hole in the wall between the left and right ventricles of the heart (ventricular septal defect)
• Closing a blood vessel that connects the aorta of the heart to the pulmonary artery (ductus arteriosis)
• Enlarging the flow from the right ventricle to the lungs
Types of surgery for absent pulmonary valve include:
• Moving the pulmonary artery to the front of the aorta and away from the airways
• Rebuilding the artery wall in the lungs to reduce pressure on the airways (reduction pulmonary arterioplasty)
• Rebuilding the windpipe and breathing tubes to the lungs
• Replacing the abnormal pulmonary valve with one taken from human or animal tissue
Infants with severe breathing symptoms may need to get oxygen or be put on a breathing machine (ventilator).

Outlook (Prognosis)

Without surgery, most infants who have severe lung complications will die.
In many cases, surgery can treat the condition and relieve symptoms.

Possible Complications

• Brain infection (abscess)
• Lung collapse (atelectasis)
• Pneumonia
• Right-sided heart failure
• Stroke

When to Contact a Medical Professional

Call your health care provider if your infant has symptoms of absent pulmonary valve. If you have a family history of heart defects, talk to your doctor before or during pregnancy.

Prevention

Although there is no way to prevent this condition, families may be evaluated to determine their risk of congenital defects.

Alternative Names

Absent pulmonary valve syndrome; Congenital absence of the pulmonary valve; Pulmonary valve agenesis

References

Bernstein D. Cyanotic congenital heart lesions: Lesions associated with decreased pulmonary blood flow. In: Kliegman RM, Behrman Re, Jenson HB, Stanton BF, eds.Nelson Textbook of Pediatrics
Brown JW, Ruzmetov M, Vijay P, Rodefeld MD, Turrentine MW. Surgical treatment of absent pulmonary valve syndrome associated with bronchial obstruction.Ann Thoracic Surg
Nölke L, Azakie A, Anagnostopoulos PV, Alphonso N, Karl TR. The Lecompte maneuver for relief of airway compression in absent pulmonary valve syndrome. Ann Thorac Surg
Park, MK.Pediatric Cardiology for Practitioners

Acanthosis nigricans

Acanthosis nigricans is a skin disorder in which there is darker, thick, velvety skin in body folds and creases.

Causes

Acanthosis nigricans can affect otherwise healthy people, or it can be related to medical problems. Some cases are genetically inherited. The condition is most commonly seen among people of African descent, in part because it is easier to see in darker skin.
Obesity can lead to acanthosis nigricans, as can some endocrine disorders. It is often found in people with obesity-related insulin resistance.
Some medicines, particularly hormones such as human growth hormone or birth control pills, can also cause acanthosis nigricans.
People with lymphoma or cancers of the gastrointestinal or genitourinary tracts can also develop severe cases of acanthosis nigricans.

Symptoms

Acanthosis nigricans usually appears slowly and doesn't cause any symptoms other than skin changes.
Eventually, dark, velvety skin with very visible markings and creases appears in the armpits, groin and neck folds, and over the joints of the fingers and toes.
Less commonly, the lips, palms, soles of the feet, or other areas may be affected. These symptoms are more common in people with cancer.

Exams and Tests

Your health care provider can usually diagnose acanthosis nigricans by looking at your skin. A skin biopsy may be needed in unusual cases.
If there is no clear cause of acanthosis nigricans, your doctor may order tests. These may include:
• Blood tests to check blood sugar level
• Endoscopy
• X-rays

Treatment

Because acanthosis nigricans usually only changes the skin's appearance, no treatment is needed. If the condition is affecting your appearance, using moisturizers containing ammonium lactate can help improve the skin's appearance.
It is important, however, to treat any underlying medical problem that may be causing these skin changes. When acanthosis nigricans is related to obesity, losing weight often improves the condition.

Outlook (Prognosis)

Acanthosis nigricans often fades if the cause can be found and treated.

When to Contact a Medical Professional

Call your health care provider if you develop areas of thick, dark, velvety skin.

References

Habif TP. Cutaneous manifestations of internal disease. In: Habif TP, ed.Clinical Dermatology
Morelli JG. Diseases of the epidermis. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds.Nelson Textbook of Pediatrics.

ACE blood test

The ACE test measures the level of angiotensin-converting enzyme (ACE) in the blood.

How the Test is Performed

A blood sample is needed.

How to Prepare for the Test

Follow your health care provider's instructions for not eating or drinking anything for up to 12 hours before the test. If you are on steroid medicine, ask your provider if you need to stop the medicine before the test, because steroids can decrease ACE levels. Do not stop any medicine before talking to your provider.

How the Test will Feel

When the needle is inserted to draw blood, some people feel moderate pain. Others feel only a prick or stinging. Afterward, there may be some throbbing or slight bruising. These soon go away.

Why the Test is Performed

This test is commonly ordered to help diagnose and monitor a disorder called sarcoidosis. People with sarcoidosis may have their ACE level tested regularly to check how severe the disease is and how well treatment is working.
This test also helps confirm Gaucher disease and leprosy.

Normal Results

Normal values vary based on your age and the test method used. Adults have an ACE level less than 40 micrograms/L.
Normal value ranges may vary slightly among different laboratories. Some labs use different measurements or test different samples. Talk to your doctor about the meaning of your specific test results.

What Abnormal Results Mean

Higher than normal ACE level may be a sign of sarcoidosis. ACE level rises or falls as sarcoidosis worsens or improves.
A higher than normal ACE level may also be seen in several other diseases and disorders, including:
• Cancer of the lymph tissue (Hodgkin disease)
• Diabetes
• Liver swelling and inflammation (hepatitis) due to alcohol use
• Lung disease such as asthma, cancer, chronic obstructive pulmonary disease, or tuberculosis
• Kidney disorder called nephrotic syndrome
• Multiple sclerosis
• Overactive thyroid (hyperthyroidism)
Lower than normal ACE level may indicate:
• Chronic liver disease
• Eating disorder called anorexia nervosa
• Steroid therapy (usually prednisone)
• Therapy for sarcoidosis
• Underactive thyroid (hypothyroidism)

Risks

Veins and arteries vary in size from one patient to another and from one side of the body to the other. Obtaining a blood sample from some people may be more difficult than from others.
The risks associated with having blood drawn are slight but may include:
• Excessive bleeding
• Fainting or feeling lightheaded
• Hematoma (blood accumulating under the skin)
• Infection (a slight risk any time the skin is broken)

Alternative Names

Serum angiotensin-converting enzyme; SACE

References

Pincus MR, Abraham NZ, Carty RP. Clinical enzymology. In: McPherson RA, Pincus MR, eds.Henry's Clinical Diagnosis and Management by Laboratory Methods
Iannuzzi M. Sarcoidosis. In: Goldman L, Schafer AI, eds.Goldman's Cecil Medicine

ACE inhibitors

Angiotensin-converting enzyme (ACE) inhibitors are medicines. They treat heart, blood vessel, and kidney problems.

Alternative names

Angiotensin-converting enzyme inhibitors

How ACE inhibitors help

ACE inhibitors are used to treat heart disease. These medicines make your heart work less hard by lowering your blood pressure. This keeps some kinds of heart disease from getting worse. Most people who have heart failure take these medicines.
These medicines treat high blood pressure, strokes, or heart attacks. They may help lower your risk for stroke or heart attack.
They are also used to treat diabetes and kidney problems. This can help keep your kidneys from getting worse. If you have these problems, ask your doctor if you should be taking these medicines.

Types of ACE inhibitors

There are many different names and brands of ACE inhibitors. Most work as well as another. Side effects may be different for different ones.

Taking your ACE inhibitors

ACE inhibitors are pills that you take by mouth. Take all of your medicines as your doctor told you to. Follow up with your doctor regularly. Your doctor will check your blood pressure and do blood tests to make sure the medicines are working properly. Your doctor may change your dose from time to time. In addition:
• Try to take your medicines at the same time(s) each day.
• Do not stop taking your medicines without talking to your doctor first.
• Plan ahead so that you do not run out of medicine. Make sure you have enough with you when you travel.
• Before taking ibuprofen (Advil, Motrin) or aspirin, talk to your doctor.
• Tell your doctor what other medicines you are taking, including anything you bought without a prescription, diuretics (water pills), potassium pills, or herbal or dietary supplements.
• Do not take ACE inhibitors if you are planning to become pregnant, pregnant, or breastfeeding. Call your doctor if you become pregnant when you are taking these medicines.

Side effects

Side effects from ACE inhibitors are rare.
You may have a dry cough. This may go away after a while. If it does not, tell your doctor. Sometimes reducing your dose helps. But sometimes your doctor will switch you to a different medication. Do not lower your dose without talking with your doctor first.
You may feel dizzy or lightheaded when you start taking these medicines, or if your doctor increases your dose. Standing up slowly from a chair or your bed may help. If you have a fainting spell, call your doctor right away.
Other side effects include:
• Headache
• Fatigue
• Loss of appetite
• Upset stomach
• Diarrhea
• Numbness
• Fever
• Skin rashes or blisters
• Joint pain
If your tongue or lips swell, call your doctor right away, or go to the emergency room. You may be having a serious allergic reaction to the medicine. This is very rare.

When to call the doctor

Call your doctor if you are having any of the side effects listed above. Also call your doctor if you are having any other unusual symptoms.

References

Mant J, Al-Mohammad A, Swain S, Laramée P; Guideline Development Group. Management of chronic heart failure in adults: synopsis of the National Institute for Health and Clinical Excellence guideline. Ann Intern Med
Januzzi JL, Mann DL. Clinical assessment of heart failure. In: Mann DL, Zipes DP, Libby P, et al. eds.Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine
Ridker PM, Libby P, Buring JE. Risk markers and the primary prevention of cardiovascular disease. In: Mann DL, Zipes DP, Libby P, et al. eds.Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine
Riegel B, Moser DK, Anker SD, et al; American Heart Association Council on Cardiovascular Nursing; American Heart Association Council on Clinical Cardiology; American Heart Association Council on Nutrition, Physical Activity, and Metabolism; American Heart Association Interdisciplinary Council on Quality of Care and Outcomes Research. State of the science: promoting self-care in persons with heart failure: a scientific statement from the American Heart Association.Circulation
Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Drazner MH, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines.Circulation

Acetaminophen and codeine overdose

Acetaminophen (Tylenol) and codeine is a prescription pain medicine. It is a narcotic, which means it has the potential to relieve pain while making you feel sleepy.
Acetaminophen and codeine overdose occurs when someone accidentally or intentionally takes more than the normal or recommended amount of this medication.
This is for information only and not for use in the treatment or management of an actual poison exposure. If you have an exposure, you should call your local emergency number (such as 911) or the National Poison Control Center at 1-800-222-1222.
See also:
• Acetaminophen overdose
• Codeine overdose
• Hydrocodone and acetaminophen overdose

Poisonous Ingredient

Acetaminophen combined with codeine

Where Found

Acetaminophen with codeine is commonly sold under the name Tylenol #3.

Symptoms

Airways and lungs:
• Breathing shallow
• Breathing slow and labored
• Respiratory arrest
Eyes, ears, nose, and throat:
• Pinpoint pupils
Heart and blood vessels:
• Low blood pressure
Nervous system:
• Coma
• Convulsions
• Drowsiness
• Stupor (lack of alertness)
Skin:
• Bluish skin (fingernails and lips)
• Cold, clammy skin
• Heavy sweating
Stomach and gastrointestinal system:
• Nausea and vomiting
• Spasms of the stomach and intestines
• Liver failure
Urinary system:
• Kidney failure

Home Care

Seek immediate medical help. This type of overdose can cause death. Do NOT make the person throw up unless told to do so by poison control or a health care professional.

Before Calling Emergency

Determine the following information:
• Patient's age, weight, and condition
• Name of the product (as well as the ingredients and strength, if known)
• Time it was swallowed
• Amount swallowed
• If the medication was prescribed for the patient

Poison Control

The National Poison Control Center (1-800-222-1222) can be called from anywhere in the United States. This national hotline number will let you talk to experts in poisoning. They will give you further instructions.
This is a free and confidential service. All local poison control centers in the United States use this national number. You should call if you have any questions about poisoning or poison prevention. It does NOT need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week.
Take the container with you to the hospital, if possible.
See: Poison control center - emergency number

What to Expect at the Emergency Room

The health care provider will measure and monitor the patient's vital signs, including temperature, pulse, breathing rate, and blood pressure. Symptoms will be treated as appropriate. The patient may be admitted to the hospital and may receive:
• Activated charcoal
• Blood and urine tests
• Breathing support (artificial respiration)
• Chest x-ray
• EKG (electrocardiogram, or heart tracing)
• Intravenous (through the vein) fluids
• Laxative
• Medication (antidote) to reverse the effects of the poison
• Tube through the mouth into the stomach to empty the stomach (gastric lavage)
If there is a high level of acetaminophen in the blood, the patient will be given N-acetyl cysteine. Without this counteracting drug, called an antidote, deadly liver failure may occur.

Outlook (Prognosis)

How well a patient does depends on the amount of medication swallowed and how quickly treatment was received. The faster a patient gets medical help, the better the chance for recovery.
If an antidote can be given, recovery from an acute overdose often occurs within 24 - 48 hours. Recovery takes longer if the liver is affected.

Prevention

Keep all medications in child-proof containers and out of reach of children. Read all medication labels and take only medications which have been prescribed for you.

Alternative Names

Tylenol # 3 overdose; Phenaphen with codeine overdose; Tylenol with codeine overdose

References

Doyon S. Opioids. In: Tintinalli JE, Kelen GD, Stapczynski JS, Ma OJ, Cline DM, eds.Emergency Medicine: A Comprehensive Study Guide.
Hung OL, Nelson LS. Acetaminophen. In: Tintinalli JE, Kelen GD, Stapczynski JS, Ma OJ, Cline DM, eds.Emergency Medicine: A Comprehensive Study Guide.
Bardsley CH. Opioids. In: Marx, JA, ed.Rosen's Emergency Medicine: Concepts and Clinical Practice.
Hendrickson RG, McKeown NJ. Acetaminophen. In: Marx, JA, ed.Rosen's Emergency Medicine: Concepts and Clinical Practice.

Acetaminophen dosing for children

Taking acetaminophen (Tylenol) can help children with colds and fever feel better. As with all drugs, it is important to give children the correct dose. Acetaminophen is safe when taken as directed. But taking too much of this medicine can be harmful.

How Acetaminophen Can Help Your Child

Acetaminophen is used to help:
• Reduce aches, pain, sore throat, and fever in children with a cold or the flu
• Relieve pain from a headache or toothache

Proper Dosing of Liquids and Tablets

Children's acetaminophen can be taken as liquid or chewable tablet.
If your child is under 2 years old, check with your health care provider before giving your child acetaminophen.
To give the correct dose, you will need to know your child's weight.
You also need to know how much acetaminophen is in a tablet, teaspoon (tsp), or 5 milliliters (mL) of the product you are using. You can read the label to find out.
• For chewable tablets, the label will tell you how many milligrams (mg) are found in each tablet, such as 80 mg per tablet.
• For liquids, the label will tell you how many mg are found in 1 tsp or in 5 mL, such as 160 mg/1 tsp or 160 mg/5 mL.
For syrups, you will need some type of dosing syringe. It may come with the medicine, or you can ask your pharmacist. Make sure to clean it out after each use.
If your child weighs 24 to 35 lbs:
• For syrup that says 160 mg/5 mL on the label: Give a dose: 5 mL
• For syrup that says 160 mg/1 tsp on the label: Give a dose: 1 tsp
• For chewable tablets that say 80 mg on the label: Give a dose: 2 tablets
If your child weighs 36 to 47 lbs:
• For syrup that says 160 mg/5 mL on the label: Give a dose: 7.5 mL
• For syrup that says 160 mg/1 tsp on the label: Give a dose: 1 ½ tsp
• For chewable tablets that say 80 mg on the label: Give a dose: 3 tablets
If your child weighs 48 to 59 lbs:
• For syrup that says 160 mg/5 mL on the label: Give a dose: 10 mL
• For syrup that says 160 mg/1 tsp on the label: Give a dose: 2 tsp
• For chewable tablets that say 80 mg on the label: Give a dose: 4 tablets
If your child weighs 60 to 71 lbs:
• For syrup that says 160 mg/5 mL on the label: Give a dose: 12.5 mL
• For syrup that says 160 mg/1 tsp on the label: Give a dose: 2 ½ tsp
• For chewable tablets that say 80 mg on the label: Give a dose: 5 tablets
• For chewable tablets that say 160 mg on the label: Give a dose: 2 ½ tablets
If your child weighs 72 to 95 lbs:
• For syrup that says 160 mg/5 mL on the label: Give a dose: 15 mL
• For syrup that says 160 mg/1 tsp on the label: Give a dose: 3 tsp
• For chewable tablets that say 80 mg on the label: Give a dose: 6 tablets
• For chewable tablets that say 160 mg on the label: Give a dose: 3 tablets
If your child weighs 96 lbs or more:
• For syrup that says 160 mg/5 mL on the label: Give a dose: 20 mL
• For syrup that says 160 mg/1 tsp on the label: Give a dose: 4 tsp
• For chewable tablets that say 80 mg on the label: Give a dose: 8 tablets
• For chewable tablets that say 160 mg on the label: Give a dose: 4 tablets
You may repeat the dose every 4 to 6 hours as needed. DO NOT give your child more than 5 doses in 24 hours.
If you are not sure how much to give your child, call your health care provider.

Proper Dosing of Suppositories

If your child is vomiting or will not take oral medicine, you can use suppositories. Suppositories are placed in the anus to deliver medicine.
You can use suppositories in children older than 6 months. Always check with your health care provider before giving any medicine to children under 2 years old.
This medicine is given every 4 to 6 hours.
If your child is 6 to 11 months:
• For infant suppositories that read 80 milligrams (mg) on the label: Give a dose: 1 suppository every 6 hours
• Maximum dose: 4 doses in 24 hours
If your child is 12 to 36 months:
• For infant suppositories that read 80 mg on the label: Give a dose: 1 suppository every 4 to 6 hours
• Maximum dose: 5 doses in 24 hours
If your child is 3 to 6 years:
• For children's suppositories that read 120 mg on the label: Give a dose: 1 suppository every 4 to 6 hours
• Maximum dose: 5 doses in 24 hours
If your child is 6 to 12 years:
• For junior-strength suppositories that read 325 mg on the label: Give a dose: 1 suppository every 4 to 6 hours
• Maximum dose: 5 doses in 24 hours
If your child is 12 years and over:
• For junior-strength suppositories that read 325 mg on the label: Give a dose: 2 suppositories every 4 to 6 hours
• Maximum dose: 6 doses in 24 hours

Giving Medicine to Children

Make sure you do not give your child more than one medicine that contains acetaminophen as an ingredient. For example, acetaminophen can be found in many cold remedies. Read the label before giving any medicine to children. You should not give medicine with more than one active ingredient to children under age 6.
When giving medicine to children, also be sure to follow important child medication safety tips.

If Your Child Takes Too Much

Be sure to post the number for the poison control center by your phone. If you think your child has taken too much medicine, call the poison control center at 1-800-222-1222. It is open 24 hours a day. Signs may include nausea, vomiting, tiredness, and abdominal pain.
Go to the nearest emergency room. Your child may need:
• To get activated charcoal. Charcoal stops the body from absorbing the medicine. It has to be given within an hour, and it does not work for every medicine.
• To be admitted to the hospital so they can be watched closely
• Blood tests to see what the medicine is doing
• To have their heart rate, breathing rate, and blood pressure monitored

When to Call the Doctor

Call your health care provider if:
• You are not sure about the dose of medicine to give your infant or child
• You are having trouble getting your child to take medicine
• Your child's symptoms do not go away when you would expect them to go away
• Your child is an infant and has signs of illness, such as fever

Alternate Names

Tylenol

References

American Academy of Pediatrics (healthychildren.org). Acetaminophen (Tylenol, etc.) Dosage Table. Available at: http://www.healthychildren.org/English/tips-tools/Symptom-Checker/Pages/Acetaminophen-Dosage-Table.aspx.Accessed September 29, 2014.
US Food and Drug Administration. Reducing Fever in Children: Safe Use of Acetaminophen. Available at: http://www.fda.gov/forconsumers/consumerupdates/ucm263989.htm#Tips.Accessed September 29, 2014.

Acetaminophen overdose

Acetaminophen (Tylenol) is a pain medicine. Acetaminophen overdose occurs when someone accidentally or intentionally takes more than the normal or recommended amount of this medication.
Acetaminophen overdose is one of the most common poisonings worldwide. People often think that this medicine is very safe. However, it may be deadly if taken in large doses.
This is for information only and not for use in the treatment or management of an actual poison exposure. If you have an exposure, you should call your local emergency number (such as 911) or 1-800-222-1222 for a local poison control center near you.

Where Found

Acetaminophen is found in a variety of over-the-counter and prescription pain relievers.
Tylenol is a brand name for acetaminophen. Other medicines that contain acatominophen include:
• Anacin-3
• Liquiprin
• Panadol
• Percocet
• Tempra
• Various cold and flu medicines
Note: This list is not all inclusive.
Common dosage forms and strengths:
• Suppository: 120 mg*, 125 mg, 325 mg, 650 mg
• Chewable tablets: 80 mg
• Junior tablets: 160 mg
• Regular strength: 325 mg
• Extra strength: 500 mg
• Liquid: 160 mg/teaspoon
• Drops: 100 mg/mL, 120 mg/2.5 mL
*mg = milligrams
You should not take more than 4000 mg of acetaminophen a day. Taking more, especially 7000 mg or more, can lead to a severe overdose if not treated.

Symptoms

• Abdominal pain
• Appetite loss
• Coma
• Convulsions
• Diarrhea
• Irritability
• Jaundice
• Nausea
• Sweating
• Upset stomach
• Vomiting
Note: Symptoms may not occur until 12 or more hours after the acetaminophen was swallowed.

Home Care

There is no home treatment. Seek immediate medical help.

Before Calling Emergency

Determine the following information:
• Patient's age, weight, and condition
• Name of the product (ingredients and strengths, if known)
• Time it was swallowed
• Amount swallowed

Poison Control

In the United States, call 1-800-222-1222 to speak with a local poison control center. This hotline number will let you talk to experts in poisoning. They will give you further instructions.This is a free and confidential service.
All local poison control centers in the United States use this national number. You should call if you have any questions about poisoning or poison prevention. You can call 24 hours a day, 7 days a week.

What to Expect at the Emergency Room

The health care provider will measure and monitor the patient's vital signs, including temperature, pulse, breathing rate, and blood pressure. Blood tests will be done to check how much acetaminophen is in the blood. The patient may receive:
• Medicines to treat symptoms
• Activated charcoal
• Laxative
• Medicine (antidote) to reverse the effect of the poison

Outlook (Prognosis)

If treatment is received within 8 hours of the overdose, there is a very good chance of recovery.
However, without rapid treatment, a very large overdose of acetaminophen can lead to liver failure and death in a few days.

Alternative Names

Tylenol overdose; Paracetamol overdose

References

Goldfrank LR, ed.Goldfrank's Toxicologic Emergencies
American Association of Poison Control Centers. Practice Guideline: Acetaminophen Poisoning: an Evidence-Based Consensus Guideline for Out-of-Hospital Management. Clinical Toxicology
Wolf SJ, Heard K, Sloan EP, Jagoda AS; American College of Emergency Physicians. Clinical policy: critical issues in the management of patients presenting to the emergency department with acetaminophen overdose.Ann Emerg Med

Acetone poisoning

Acetone is a chemical used in many household products. This article discusses poisoning from swallowing acetone-based products. Poisoning may also occur from breathing in fumes or absorption through the skin.
This is for information only and not for use in the treatment or management of an actual poison exposure. If you have an exposure, you should call your local emergency number (such as 911) or a local poison control center at 1-800-222-1222.

Poisonous Ingredient

Acetone; Dimethyl formaldehyde; Dimethyl ketone

Where Found

• Fingernail polish remover
• Some cleaning solutions
• Some glues, including rubber cement
• Some lacquers
Note: This list may not be all-inclusive.

Symptoms

Cardiovascular system
• Low blood pressure
Gastrointestinal system
• Nausea
• Pain in belly area (abdomen)
• Person may have a fruity odor
• Sweet taste in mouth
• Vomiting
Nervous system
• Acting as if drunk
• Coma
• Drowsiness
• Stupor (confusion, decreased level of consciousness)
• Uncoordination
Respiratory system
• Difficulty breathing
• Slowed breathing rate
• Shortness of breath
Urinary system
• Increased need to urinate

Home Care

Seek immediate medical help. Do NOT make a person throw up unless told to do so by poison control or a health care professional.

Before Calling Emergency

Determine the following information:
• The patient's age, weight, and condition
• The name of the product (ingredients and strengths if known)
• The time it was swallowed
• The amount swallowed

Poison Control

In the United States, call 1-800-222-1222 to speak with a local poison control center. This hotline number will let you talk to experts in poisoning. They will give you further instructions.
This is a free and confidential service. You should call if you have any questions about poisoning or poison prevention. It does NOT need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week.
Take the container with you to the hospital, if possible.
See: Poison control center - emergency number

What to Expect at the Emergency Room

The health care provider will measure and monitor the patient's vital signs, including temperature, pulse, breathing rate, and blood pressure. Symptoms will be treated as appropriate. The patient may receive:
• Blood tests
• Chest x-ray
• Intravenous fluids (fluids given through a vein)
• Tube through the nose into the stomach to empty the stomach (gastric lavage)
• Oxygen, if needed

Outlook (Prognosis)

Accidentally drinking small amounts of acetone/nail polish remover is unlikely to harm you as an adult. However even small amounts can be dangerous to your child, so it is important to keep this and all household chemicals in a safe place.
If the person survives past 48 hours, the chances for recovery are good.

Prevention

Keep all poisons in their original and/or childproof container, with labels visible, and out of the reach of children.

Alternative Names

Dimethyl formaldehyde poisoning; Dimethyl ketone poisoning; Nail polish remover poisoning

References

White SA.Toxic Alcohols. In: Marx JA, ed.Rosen's Emergency Medicine: Concepts and Clinical Practice
Published for educational purposes from the website: MedlinePlus
Disclaimer: The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

SEARCH CONTENTS

Custom Search