one of the myriad reasons why acetaminophen (tylenol) should be a controlled substance

yeah, that's right. over the counter, my ass. acetaminophen is a very dangerous drug. it is the number 1 cause of liver failure in this country. I would advise all of you to stay away from it in general.

But liver is not the focus of today's discussion. Instead, the kidneys are in the hot seat, since that is the block I am doing right now (and happily about to finish up for now, once I slog through the diuretics).

Kidneys are under appreciated by the lay public. Really. They get 25% of the cardiac output (what the heart pumps out). Just think about how tiny kidneys are - at the size of your fist, 2 fists get a quarter of your blood. But with great privilege comes great responsibility, in the sense that the kidneys are among the first organs to be affected if you lose blood or can't pump enough blood, like when you are having a heart attack. So what can happen is, you stop getting enough blood to your kidneys, your kidneys stop producing urine, going into something called acute tubular necrosis. Necrosis is definitely what it sounds like.

So you are in acute tubular necrosis, you aren't peeing and you DIE!!!! How? You aren't getting rid of potassium while you are not producing urine, and high potassium can cause your heart to beat irregularly, leading to cardiac standstill. Cardiac standstill means your brain isn't getting O2, and neurons can only survive for a few minutes without O2. So boom. Done.

Back to acetaminophen. If you take a lot of it, it can produce free radicals - these are the things that antioxidants fight - and damage your renal tubules (where filtration happens). Then you decide to take some aspirin too, maybe because you have high blood pressure and you want to thin the blood a little. Aspirin produces a chemical that will dilate blood vessels, but this isn't good because with dilated arteries you don't filter as much. All of this combined freaks your body out, and decides that it wants you to filter more stuff, and a chemical called angiotension 2 causes the arteries in your kidneys to constrict. But the capillaries around your filtering tubes constrict too, depriving them of O2, and they are already hurt from being bombarded by acetaminophen with free radicals. The kidney tubules die, and little pieces of your kidneys slough off into your pee, along with blood and protein. And slowly, like the final scene in LOST, everything fades to white.

ok. too much science. back to drugs.

on this 13th day of studying, I am signing out.