A 22-year-old female presents to the emergency department 4 hours after intentionally ingesting an unknown quantity of acetaminophen. She is asymptomatic. Her serum acetaminophen level is drawn and returns at 180 mcg/mL. What is the most appropriate management?

✓ Correct Answer: Option C

A serum acetaminophen level of 180 mcg/mL at 4 hours post-ingestion is above the Rumack-Matthew nomogram treatment line. N-acetylcysteine (NAC) is the antidote for acetaminophen overdose and should be initiated promptly to prevent hepatotoxicity. Activated charcoal is only effective if given within 1 hour of ingestion.