Larry
Forum Newbie
Topics: 8
Posts: 21
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3Y/O girl, acetaminophen pills almost 50, 325mg each. Less than one hour brought by parents to ER. Upon arrival vitals
HR120 R 24/min, pt is awake and oriented. Which of the following is the most appropriate next step in the management?
1. Administer activated charcol
2. Administer N-acetylcysteine IV.
3. Administer N-acetylcysteine PO.
4. Supportive care and measurement of plasma concentration of acetaminophen 3 hours later.
Answer 4.
I think 1 is right.
Gastric emptying if <2hr since ingestion;
activated charcol if <4hr since ingestion;
Draw blood level @ 4hr and use available nomogram to assess risk of hepatotoxicity. If toxic, start N-acetylcysteine.
Any comments? Fried Water, what do you think?
Thanks.
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| meg
Forum Guru
Topics: 62
Posts: 806
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Larry, one has to wait till 4 hours are passed before deciding the toxicity level in any patient with Acetaminophen poisoning. (Kaplan notes)- I did the online qbank recently, they mentioned this reason for the answer.
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| Larry
Forum Newbie
Topics: 8
Posts: 21
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Meg, Draw blood level @ 4hr and use available nomogram to assess risk of hepatotoxicity. If toxic, start N-acetylcysteine. It's right. I agree with you.
But activated charcol is one of the listed options, I'd choose both 1 and 4.
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| fried water
Forum Junior
Topics: 4
Posts: 57
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hey larry,
i think this question is too relative and even choice one doesnt seem wrong, but always remember that we have to chose the best answer and here i think you can justify choice 4 as best coz it includes the 'supportive care' (which might include adminstering charcoal and even gartic emtying) + measuring plasma levels, which sure has to be the done too'
..but in all i think it tricky and mle shud ideally, accroding to me, shud not have such questions!
 thats what i think.
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| Larry
Forum Newbie
Topics: 8
Posts: 21
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You're right! Thanks.
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