Number
416
Name
Same Overdose, Different Management: A Novel Approach to Teaching Acetaminophen Overdose
Date & Time
Sunday, June 7, 2026, 5:30 PM - 7:00 PM
Location Name
Oglethorpe Ballroom
Speakers
Authors
Akhila Kunuthuru, Virginia Commonwealth University School of Medicine
Sonali Chu, Virginia Commonwealth University School of Medicine
Mariana Fernandes Gragnani, Virginia Commonwealth University School of Medicine
Ivanna Dudala, Virginia Commonwealth University School of Medicine
Dalia Allaw, Virginia Commonwealth University School of Medicine
Carolyn Neves, Virginia Commonwealth University School of Medicine
Muzaffar Nazarov, Virginia Commonwealth University School of Medicine
Michelle Troendle, Department of Emergency Medicine, Virginia Commonwealth University Health
Presentation Topic(s)
Instructional Methods
Description
PURPOSE
Acetaminophen (APAP) is a commonly used over-the-counter medication. APAP
overdose is prevalent, accounting for approximately 56,000 emergency
department visits annually and is the leading cause of acute liver failure in
the U.S.. Overdose is treated with N-acetylcysteine (NAC). For decades, its
dosage was determined based on patient weight rather than the amount
ingested. In 2021, clinical guidelines introduced high-dose NAC for cases involving
massive acetaminophen ingestion. Given the prevalence of APAP overdose, its
potentially life-threatening consequences, recent updates in management
protocols, and the benefits of hands-on learning, we aim to provide a
simulation case learning tool for medical students on massive APAP overdose.
METHODS
We conducted a quasi experimental pretest posttest study. Fourth-year
medical students took a pretest on APAP, then attended a lecture followed by
three simulated cases of APAP overdoses that varied in timing and magnitude.
Students completed a focused toxicological history and physical examination.
They administered NAC in regular or high doses as appropriate. Small
variations in clinical presentations allowed for student practice with the
treatment algorithm, including oral NAC or adjuncts with fomepizole. Outcome
measures were a posttest.
RESULTS
Sixty-one students participated; mean pretest and posttest scores were
56.84% and 89.40%, respectively. A Wilcoxon signed rank test yielded a
statistically significant difference between the scores (test statistic 7.0,
p<0.0001).
CONCLUSION
Updates to clinical guidelines may complicate decision-making in the
management of APAP overdoses. These simulations provide students with an
opportunity to treat it in a controlled setting prior to encountering it in
clinical practice. Presenting multiple simulated APAP overdose cases with
variations is a feasible and effective method for strengthening diagnostic
skills in accordance with updated clinical guidelines that can be
incorporated into toxicology medical education curriculum.
Acetaminophen (APAP) is a commonly used over-the-counter medication. APAP
overdose is prevalent, accounting for approximately 56,000 emergency
department visits annually and is the leading cause of acute liver failure in
the U.S.. Overdose is treated with N-acetylcysteine (NAC). For decades, its
dosage was determined based on patient weight rather than the amount
ingested. In 2021, clinical guidelines introduced high-dose NAC for cases involving
massive acetaminophen ingestion. Given the prevalence of APAP overdose, its
potentially life-threatening consequences, recent updates in management
protocols, and the benefits of hands-on learning, we aim to provide a
simulation case learning tool for medical students on massive APAP overdose.
METHODS
We conducted a quasi experimental pretest posttest study. Fourth-year
medical students took a pretest on APAP, then attended a lecture followed by
three simulated cases of APAP overdoses that varied in timing and magnitude.
Students completed a focused toxicological history and physical examination.
They administered NAC in regular or high doses as appropriate. Small
variations in clinical presentations allowed for student practice with the
treatment algorithm, including oral NAC or adjuncts with fomepizole. Outcome
measures were a posttest.
RESULTS
Sixty-one students participated; mean pretest and posttest scores were
56.84% and 89.40%, respectively. A Wilcoxon signed rank test yielded a
statistically significant difference between the scores (test statistic 7.0,
p<0.0001).
CONCLUSION
Updates to clinical guidelines may complicate decision-making in the
management of APAP overdoses. These simulations provide students with an
opportunity to treat it in a controlled setting prior to encountering it in
clinical practice. Presenting multiple simulated APAP overdose cases with
variations is a feasible and effective method for strengthening diagnostic
skills in accordance with updated clinical guidelines that can be
incorporated into toxicology medical education curriculum.
Presentation Tag(s)
Student Presentation