A 24-year-old male presents 6 hours after ingesting 25 grams of acetaminophen with toxic suicidal intent. What specific antidote must be administered immediately?
Answer and explanation
Correct answer: A. Intravenous N-acetylcysteine
- Step 1: Acetaminophen overdose saturates glucuronidation and sulfation pathways, shunting metabolism to CYP2E1 which produces the hepatotoxic metabolite NAPQI.
- Step 2: N-acetylcysteine acts as a glutathione precursor and substitute, binding and detoxifying NAPQI to prevent fatal centrilobular hepatic necrosis.
Answer
Intravenous N-acetylcysteine.
Why not the others: Deferoxamine is a specific chelating agent for acute iron poisoning. Flumazenil is a benzodiazepine antagonist that carries a risk of refractory seizures in mixed overdoses. Pralidoxime reactivates acetylcholinesterase in organophosphate pesticide poisoning.
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