A 19-year-old presents 5 hours after an intentional acetaminophen ingestion. She is nauseated, ALT is normal, INR 1.1, and the serum acetaminophen

Question

A 19-year-old presents 5 hours after an intentional acetaminophen ingestion. She is nauseated, ALT is normal, INR 1.1, and the serum acetaminophen level plots above the treatment line on the Rumack-Matthew nomogram. What is the most appropriate initial management?

Accepted Answer

Start intravenous N-acetylcysteine

Answer

Wait for transaminase elevation before antidotal treatment

Answer

Give activated charcoal alone and discharge after repeat vitals

Answer

Arrange dialysis based on the nomogram result

Answer

Administer fomepizole and bicarbonate infusion

Acetaminophen poisoning — RCPSC EM MCQ

A 19-year-old presents 5 hours after an intentional acetaminophen ingestion. She is nauseated, ALT is normal, INR 1.1, and the serum acetaminophen level plots above the treatment line on the Rumack-Matthew nomogram. What is the most appropriate initial management?