Question

A 35-year-old man presents 3 hours after ingesting approximately 25 g (50 tablets of 500 mg) of acetaminophen in a suicide attempt. He is asymptomatic. Serum acetaminophen level at 4 hours will be available. According to Canadian toxicology guidance, what is the most appropriate management?

Accepted Answer

Use the Rumack-Matthew nomogram at 4 hours post-ingestion to determine the need for N-acetylcysteine and start treatment if the level is above the treatment line

Answer

No treatment is needed if he is asymptomatic

Answer

Wait for liver enzymes to rise before treating

Answer

Give activated charcoal only and discharge

Answer

Treat only if he becomes jaundiced

Practice question

A 35-year-old man presents 3 hours after ingesting approximately 25 g (50 tablets of 500 mg) of acetaminophen in a suicide attempt. He is asymptomatic. Serum acetaminophen level at 4 hours will be available. According to Canadian toxicology guidance, what is the most appropriate management?