This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Pharmacology
All are latest treatment modalities for acetaminophen overdosage, EXCEPT: 
Select and explain. 
A. Gastric lavage, B. Oral activated charcol, C. Cysteamine, D. High dose vitamin E
D: High dose vitamin E
Answer: D: High dose vitamin E 
Explanation: Acetaminophen causes severe centrilobular hepatic necrosis. It can causes fatal disease if the ingestion exceeds > 25g. If blood level; > 300 microgram after 4 hours of ingestion indicates and predicts severe liver damage. Treatment options Gastric lavage Suppoive measures Activated charcoal Cholestyramine Cysteamine, cysteine and N acetyl cysteine reduce severity of hepatic necrosis (Sulhydil group) Therapy should be begin within 8 hours If serum lactate level is more than 3.5 millimoles per litre high risk of moality Vitamin E in high dose is used in the treatment of NASH. Ref: Harrison, Edition-18, Page-2563