Question

A 28-year-old man presents to the emergency department 3 hours after ingesting an estimated 20 g of acetaminophen in a suicide attempt. He is asymptomatic. Serum acetaminophen drawn at 3 hours post-ingestion is 120 µg/mL. What is the most appropriate next step?

Accepted Answer

Repeat the acetaminophen level at 4 hours post-ingestion and use the Rumack-Matthew nomogram to decide on N-acetylcysteine

Answer

Reassure and discharge because he is asymptomatic

Answer

Start N-acetylcysteine immediately without further levels

Answer

Wait 24 hours and then check liver enzymes

Answer

Induce vomiting at home

Practice question

A 28-year-old man presents to the emergency department 3 hours after ingesting an estimated 20 g of acetaminophen in a suicide attempt. He is asymptomatic. Serum acetaminophen drawn at 3 hours post-ingestion is 120 µg/mL. What is the most appropriate next step?