An adolescent client ingests a large number of acetaminophen tablets in an attempt to commit suicide. Which laboratory result is associated with acetaminophen overdose?

  1. metabolic alkalosis
  2. increased blood urea nitrogen level
  3. decreased hemoglobin and hematocrit
  4. elevated liver enzyme levels
Number 4 is correct.
Rationale: Metabolism of acetaminophen occurs primarily in the liver, causing an elevation of liver enzyme levels. Metabolic alkalosis is not associated with acetaminophen overdose. Blood urea nitrogen level results from metabolism of protein by the liver and is not associated with acetaminophen overdose. A decrease of hemoglobin and hematocrit is consistent with anemia.