``MY TOOTH IS KILLING ME!'': OVER THE COUNTER ANALGESIC RISKS AND HEPATITIS C. E. Coffey 1 , E. Schneider 1 ; 1 Hennepin County Medical Center, Minneapolis, MN (Tracking ID #76561) LEARNING OBJECTIVES: 1. Recognize increased risks of acetaminophen and nonsteroidal antiinflammatory drugs (NSAIDs) for patients with Hepatitis C. 2. Recognize importance of adequate medical and medication history, even for common complaints. CASE INFORMATION: 50 year old male presented to a walk-in clinic seeking medication for a two week old toothache. Nonprescription pills at home didn't help. He also reported 2 days of nausea, vomiting, loose bowel movements, diffuse myalgias, generalized weakness. He denied alcohol, infectious contacts. PMH included hepatitis C, alcohol and cocaine use. Physical exam remarkable only for an ill appearing male with an abscessed tooth and mild abdominal tenderness. Labs included K 3.8, BUN 32, creatinine 2.9, ALT 3460, AST 2575, bilirubin 5.1, alk p'tase 135, lipase 111, INR 1.4. Acetaminophen level 52. Salicylate level was not elevated. He later admitted to taking up to 20 tablets of naproxen and acetaminophen a day over the last few days. He was admitted to the medicine service, and improved with acetylcysteine and supportive care. He was counselled about acetaminophen use. A dentist extracted the abscessed tooth before discharge. IMPLICATIONS/DISCUSSION: Acetaminophen and NSAIDs are associated with increased transaminases in patients with hepatitis C. Renal failure has been associated with NSAIDs and with paracetamol poisoning.This case illustrates that the presenting problem isn't always the most serious. The non-pain symptoms, past history and specific information on his self medication were keys to diagnosis. Given potential toxicities of analgesics, patients with hepatitis C are well advised to seek advice for pain issues rather than self medicating.