A Lethargic Infant with Vomiting Muhammad Waseem, MD Dr. Waseem is an Assistant Professor of Emergency Medicine, Weill Medical College of Cornell University, New York, NY. The questions below are based on the April 2003 Pediatric Rounds article, “A Lethargic Infant with Vomiting.” Choose the single best answer for each question.
	1. What is the initial dose of N-acetylcysteine (NAC) for a presumed acetaminophen overdose? 40 mg/kg 70 mg/kg 100 mg/kg 140 mg/kg 200 mg/kg Click here to compare your answer. 2. What is the major route of metabolism of acetaminophen in children? Cytochrome P-450 system Demethylation Glucuronidation Oxidative phosphorylation Sulfation Click here to compare your answer.		3. Which one of the following detoxifying substances is produced following the administration of NAC? Glucuronide Glutathione Glycine N-acetyl-p-benzoquinone imine (NAPQI) Sulfate Click here to compare your answer. 4. Which one of the following statements regarding acetaminophen toxicity is correct? An intravenous form of NAC is preferred for treatment. Most children develop hepatic toxicity. Prothrombin time at 4 hours post-ingestion is the best predictor of hepatic toxicity. Serum transaminase levels begins to rise within 18 to 24 hours of ingestion. The Rumack-Matthew nomogram is useful in predicting heptotoxicity in both acute and chronic acetaminophen overdoses. Click here to compare your answer.
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