400) A 28 year old woman with history of depression is brought to the emergency room by her friend after she purposefully took large number of acetaminophen tablets. Her friend can not estimate how many tablets she took but she says there were at least fifty extra strength tablets in the bottle and the bottle was found empty when she went to visit her. She last spoke with her 18 hours ago over the phone when she sounded very depressed. So, her friend reports she probably must have ingested these tablets at least 12 to 18 hrs ago. On examination, she is drowsy but arousable. Her liver function tests are within normal limits and an acetaminophen level is 15µg/ml . Serum electrolytes, creatinine , prothrombin time and INR are within normal limits. Which of the following is the initial step in management
A) Hemo-Dialysis
B) Supportive care with strict monitoring of Liver function, Creatinine and INR
C) Activated Charcoal
D) N-Acetyl Cysteine
E) Consult Liver Transplant expert
