A young female is brought to the emergency department after a suicidal attempt with acetaminophen overdose. Which of the following statements about acetaminophen overdose is correct?
A) Symptoms include extremity pain with physical findings of peripheral neuropathy.
B) Toxic effects rarely occur with ingestion of greater than 140 to 150 mg per kg of acetaminophen.
C) Elevations in liver tests peak 3 to 4 hours after ingestion.
D) Blood levels obtained 4 hours after ingestion determine treatment.
E) Treatment involves the use of deferoxamine.
Answer And Discussion:
The answer is D. (Blood levels obtained 4 hours after ingestion determine treatment)
Acetaminophen overdose is not uncommon. Most cases involve children younger than 6 years. Toxic effects occur when the doses exceed 140 to 150 mg per kg or a total dose of 7.5 g. The drug primarily
affects the liver 24 to 72 hours after ingestion by depleting glutathione stores and causing hepatocellular necrosis. Symptoms include nausea, vomiting, and right-upper quadrant abdominal pain. Acetaminophen levels should be checked 4 hours after ingestion and plotted on the Rumack–
Matthew nomogram. Peak aspartate aminotransferase, alanine aminotransferase (ALT), bilirubin, and prothrombin time (PT) values are seen 3 to 4 days after ingestion.
Treatment, including emesis induced by syrup of ipecac, gastric lavage, and administration of activated charcoal, should be initiated as soon as possible. A 4-hour acetaminophen level greater than 150 μg per mL requires administration of the antidote acetylcysteine (Mucomyst). For maximal therapeutic effect, Nacetylcysteine should be administered within 8 hours of acetaminophen ingestion.
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