Which statement about inducing emesis in acetaminophen overdose is true?

• A. Emesis should always be performed
• B. N-acetylcysteine with 140 mg/kg loading dose
• C. Activated charcoal within one hour
• D. Ipecac used to force emesis—only if patient is not altered

Answer: (D)

Gastric decontamination decisions hinge on time since ingestion and the patient’s ability to protect the airway. Emesis is not routinely performed in acetaminophen overdose because it often doesn’t remove much toxin and carries a real risk of aspiration; if emesis is ever considered, it is restricted to patients who can protect their airway, historically using ipecac to induce vomiting. The statement reflects that conditional approach—emesis with an agent like ipecac would be considered only in an alert patient with an intact airway. In practice, management focuses on airway protection, activated charcoal within about one hour if appropriate, and antidotal therapy with N-acetylcysteine, with the latter addressing the toxin’s effects rather than relying on emesis.