An adolescent patient is admitted after ingesting 20 500 mg acetaminophen (Tylenol) tablets as a suicide attempt. The patient is currently nauseated, vomiting, and diaphoretic with a BP of 96/52

Question

What will be the priority in this patient's care? 1. Have a serum acetaminophen level drawn.
2. Observe for possible urticaria and bronchospasms.
3. Provide the first oral dose of acetylcysteine (Mucomyst) in orange juice.
4. Start an intravenous access line for rehydration.

Answer 1

1
Rationale 1: The predicted risk of toxicity from a single acute overdose relies on the time of ingestion and serum acetaminophen level. Whether a level is toxic or nontoxic can only be interpreted when the time of ingestion is accurately accounted for. The Rumack-Matthew nomogram can be used to predict hepatic toxicity between 4 and 24 hours after an acute ingestion.
Rationale 2: These symptoms are side effects of intravenous administration of acetylcysteine NAC (Mucomyst).
Rationale 3: This medication is administered after the initial acetaminophen level is drawn. It must be administered within 4–24 hours after acetaminophen.
Rationale 4: This will depend upon the patient's status.