A 38-year-old man is found confused beside an empty acetaminophen bottle. The time and amount of ingestion are unknown. Acetaminophen concentration

Question

A 38-year-old man is found confused beside an empty acetaminophen bottle. The time and amount of ingestion are unknown. Acetaminophen concentration is 38 micrograms/mL, AST is 1,420 U/L, INR is 1.9, creatinine is 1.6 mg/dL, and glucose is 68 mg/dL. Which antidotal strategy is most appropriate?

Accepted Answer

Begin N-acetylcysteine immediately without waiting to reconstruct the ingestion time

Answer

Withhold N-acetylcysteine unless the aminotransferases exceed 3,000 U/L

Answer

Plot the concentration at an assumed 4-hour time and withhold treatment below the line

Answer

Repeat the acetaminophen concentration in 24 hours before deciding on antidote use

Answer

Give activated charcoal alone because hepatic injury means N-acetylcysteine is too late

Sleeve gastrectomy staple-line leak — USMLE Step 3 MCQ

A 38-year-old man is found confused beside an empty acetaminophen bottle. The time and amount of ingestion are unknown. Acetaminophen concentration is 38 micrograms/mL, AST is 1,420 U/L, INR is 1.9, creatinine is 1.6 mg/dL, and glucose is 68 mg/dL. Which antidotal strategy is most appropriate?