A child who ingested 18 500-mg acetaminophen tablets 30 minutes ago is seen in the ED. Which of these orders should the nurse do first ?

  • activated charcoal per pharmacy
  • start an IV with D5W to keep the vein open
  • gastric lavage PRN
  • acetylcysteine (Mucomyst) for age per pharmacy
Number 3 is correct.
The maximum recommended dose for acetaminophen is 4 g/day. The client ingested 9 g as a one-time dose, which is sufficient to induce liver impairment. The priority action is to remove as much of the medication from the stomach as possible. The second action would be activated charcoal. IV fluids will not affect the metabolism of acetaminophen by the liver yet may be used to maintain hydration. Acetylcysteine is effective in third-stage liver injury; given the time interval of ingestion, it would be premature to administer this pharmaceutical.