An emergency department nurse prepares to treat a child with acetaminophen overdose. The nurse reviews the physician's prescriptions, expecting that which of the following will be prescribed?

1. A

   Protamine sulphate

2. B

   Succimer

3. C

   Vitamin

4. D

   Acetylcysteine

Appeared in: DHS Staff Nurse - 2018 (Shift-2nd)

Explanation

• Acetylcysteine is the specific antidote for acetaminophen (paracetamol) poisoning.
• It works by replenishing hepatic glutathione stores, which are depleted during an acetaminophen overdose.
• Restored glutathione levels allow for the detoxification of the harmful metabolite, N-acetyl-p-benzoquinone imine (NAPQI), preventing severe liver damage.
• Treatment is most effective when started within 8 hours of ingestion but is still indicated for later presentations.
• It can be administered both intravenously and orally.

Why Other Options Were Wrong

• Option A: Protamine sulphate is an anticoagulant reversal agent, not an antidote for acetaminophen.
• Option B: Succimer is a chelating agent used for heavy metal poisoning, not for drug overdoses like acetaminophen.
• Option C: Vitamin K is involved in the synthesis of clotting factors and is not the antidote for acetaminophen.

Related Visual

Clinical Relevance

• Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Pharmacological antidote for acetaminophen toxicity in acute care settings.
• Accurate assessment of the time and amount of ingestion is a critical nursing responsibility, as it directly informs the use of the Rumack-Matthew nomogram and the urgency of treatment.
• Nurses must be prepared to manage the adverse effects of acetylcysteine, particularly nausea and vomiting with the oral form, which can be managed by administering antiemetics and diluting the dose.
• Patient and family education on the safe use of over-the-counter medications containing acetaminophen is a key role for nurses in preventing accidental overdoses, especially in children.

How to Approach the Question

• First, identify the core of the question: it asks for the specific antidote for an acetaminophen overdose.
• Recognize this as a factual recall question from pharmacology, which requires knowing specific drug-antidote pairings.
• Systematically review the options provided. Each option is an antidote for a different substance.
• Recall or deduce the correct pairing: Acetaminophen toxicity is treated with Acetylcysteine.
• Eliminate the incorrect options by identifying their correct uses: Protamine sulphate for heparin, Succimer for heavy metals, and Vitamin K for warfarin.
• Confirm the choice of Acetylcysteine as the only appropriate answer in the context of acetaminophen overdose.

Concept Tested & Keywords

• Concept Tested: Pharmacological antidote for acetaminophen toxicity.
• Stem keywords: acetaminophen overdose, child, emergency department, antidote
• Lead-in keywords: expecting, prescribed
• Clinical cues: Child with acetaminophen overdose, which requires prompt and specific intervention to prevent liver failure.

Question ID

Q6mJvV80iaMWJYyAt3nB6k

Copy ID

Reference Book

E6 Medicine Davidson Principles Practice 24e p. 158-160

E6 Pharmacology Nursing Lilley 11e Part 1 p. 176-178

E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 755-757