First-line management for acetaminophen intoxication is which of the following?

Prepare for the Adult-Gerontology Acute Care Nurse Practitioner Test. Study with interactive quizzes and detailed explanations. Boost your exam readiness with our diverse question formats and in-depth content coverage.

Acetaminophen overdose injures the liver mainly by forming a toxic metabolite (NAPQI) when glutathione stores are depleted. The antidote, N-acetylcysteine, acts as a sulfhydryl donor that replenishes glutathione and also helps detoxify NAPQI, thereby preventing or limiting hepatic injury. Because liver damage can progress even after the overdose, NAC is started promptly whenever overdose is suspected or when level/timing indicates risk, rather than waiting for results alone. The standard initial dose is a loading amount of 140 mg/kg (given orally or IV), followed by maintenance dosing per protocol. This approach addresses the toxin directly and is the mainstay of therapy. Decontamination methods like emesis or gastric lavage have limited benefit and can be harmful, and while activated charcoal can reduce absorption if given very early, it does not replace the antidote.