A 24-year-old man with a history of depression is brought to the emergency room because of a drug overdose. He is experiencing some nausea and vomiting, but no other symptoms. Physical examination and vital signs are normal. Six hours prior to presentation, he intentionally took 40 tablets of acetaminophen (500 mg/tablet). Baseline acetaminophen level, liver enzymes and function are drawn, and he is admitted to the hospital. Which of the following is the most appropriate next step in management?
TV-acetylcysteine probably acts by providing a reservoir of sulfhydryl groups to bind the toxic metabolite of acetaminophen. Narcan is effective for narcotic overdose, and ethanol is the antidote for methanol intoxication.
give ethanol to compete with the parent drug for metabolism, therefore preventing formation of toxic metabolites
give Narcan to block its actions directly
give intravenous prostacyclin to maintain cellular integrity
give N-acetyl cysteine to allow binding of the toxic metabolite
G.I.T.