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Acetaminophen toxicity — ABEM Board MCQ

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ModerateToxicologyAcetaminophen toxicityABEM Board

A 27-year-old woman arrives 10 hours after ingesting an unknown quantity of acetaminophen. Triage acuity is ESI 2; BP 118/72 mm Hg, HR 102/min. She has nausea and mild right upper quadrant tenderness. Acetaminophen level is above the treatment line on the nomogram. Which of the following is the most appropriate next step in management?

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Correct answer: E — Start N-acetylcysteine therapy

Acetaminophen concentration above the Rumack-Matthew treatment line requires N-acetylcysteine, even before transaminases rise.

Reference: American College of Medical Toxicology acetaminophen guidance