Overdose And Exposure Management Practice Test

A 34-year-old male (weight 76 kg) presents 6 hours after intentionally ingesting 40 tablets of acetaminophen 500 mg (total 20 g). Current medications: none. Medical history: alcohol use disorder (drinks daily). Allergies: none known. Vitals: blood pressure 118/70 mmHg, heart rate 98 bpm, respiratory rate 16/min, oxygen saturation 99% on room air; he reports nausea and diaphoresis. Labs: serum acetaminophen concentration 210 micrograms/mL at 6 hours (elevated), aspartate aminotransferase 48 U/L, alanine aminotransferase 52 U/L, international normalized ratio 1.2, serum creatinine 0.9 mg/dL. Which antidote is most appropriate for this overdose?

A 67-year-old female (weight 70 kg) presents with confusion and vomiting after her family reports she accidentally took an extra day’s worth of her medications, including metformin and glipizide, about 3 hours ago. Current medications: metformin 1000 mg by mouth twice daily, glipizide 10 mg by mouth daily, atorvastatin 40 mg by mouth nightly, amlodipine 10 mg by mouth daily. Medical history: type 2 diabetes, hypertension, hyperlipidemia. Allergies: sulfonamide antibiotics (hives). Vitals: blood pressure 136/78 mmHg, heart rate 88 bpm, respiratory rate 18/min, oxygen saturation 97% on room air. Labs: point-of-care glucose 38 mg/dL (critically low), serum creatinine 1.0 mg/dL, aspartate aminotransferase 24 U/L, alanine aminotransferase 20 U/L. Which antidote is most appropriate for this overdose?