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Acetaminophen overdose — RCPSC EM MCQ

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ModerateToxicologyAcetaminophen overdoseRCPSC EM

A 25-year-old presents 8 hours after ingesting 20 g acetaminophen. She is nauseated but alert. ALT is normal, INR is 1.1, creatinine is normal, and the 8-hour acetaminophen concentration plots above the treatment line. What is the most appropriate initial management?

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Correct answer: B — Start IV N-acetylcysteine

Start IV N-acetylcysteine is correct: the clues indicate Acetaminophen overdose and this option addresses the immediate ED priority. The distractors delay care, target a less likely problem, or are unsafe in this physiology.

Reference: Goldfrank's Toxicologic Emergencies; Canadian poison centre practice