10.1 Assessment Questions

A 32-year-old female presents 2 hours after intentionally ingesting 22 grams of acetaminophen in a suicide attempt. Vital signs are normal. Which of the following is the best next step in management?

A 47-year-old male with alcoholic cirrhosis takes 6 grams of acetaminophen daily for the past week for back pain. He presents with fatigue and tea-colored urine. Labs show AST 650 U/L, ALT 800 U/L, INR 1.7. What is the best initial management?

A mother brings her 3-year-old daughter to the ED 6 hours after accidentally ingesting an unknown amount of acetaminophen liquid. The child vomits frequently. What antidotal therapy is preferred?

A 60 kg adult female presents 8 hours after ingesting a single supratherapeutic dose of acetaminophen. Her serum acetaminophen level is 120 mcg/mL. She is started on intravenous N-acetylcysteine. What is the best loading dose?

A 57-year-old male is receiving intravenous N-acetylcysteine for suspected acetaminophen toxicity. He develops diffuse urticaria 30 minutes into the infusion. What is the most appropriate action?

A 22-year-old male presents with altered mental status 16 hours after unknown acetaminophen ingestion. His AST is 2500 U/L, ALT 3000 U/L, and INR 3.5. He meets criteria for liver transplantation. When should intravenous N-acetylcysteine be discontinued?

A 16-year-old female is 20 weeks pregnant and intentionally ingested 42 grams of acetaminophen 10 hours ago. Her acetaminophen level is 275 mcg/mL. She is started on acetylcysteine. What is the preferred antidotal regimen?

A 72-year-old male presents 2 hours after intentional ingestion of 30 grams of acetaminophen with oxycodone. His acetaminophen level is 890 mcg/mL. What adjuvant therapy is recommended with intravenous N-acetylcysteine?

A 38-year-old female took 4 grams of acetaminophen daily for migraine headaches over the past 10 days. She presents with fatigue, nausea, and jaundice. Her AST is 1800 U/L and INR is 2.5. What is the priority management step?

A 41-year-old male presents 8 hours after ingesting an unknown amount of acetaminophen and ethanol. His acetaminophen level is 50 mcg/mL and AST is 1200 U/L. How long should he receive intravenous N-acetylcysteine?