Paracetamol overdose early management — UKMLA MCQ

Correct answer: B — Administer a single dose of activated charcoal now

The correct answer is B. He has taken 15 g, approximately 214 mg/kg, and presents within 1 hour with an intact airway. Activated charcoal should therefore be administered promptly to reduce gastrointestinal absorption. A plasma paracetamol concentration is still required at 4 hours or later because an earlier result cannot be interpreted reliably using the treatment nomogram. Deferring all treatment would miss the time-sensitive opportunity for decontamination. Immediate N-acetylcysteine is not routinely required for a reliably timed, single acute ingestion presenting this early; it is guided by the timed concentration unless the ingestion is staggered, its timing is uncertain, or exceptional severe-poisoning features apply. Induced emesis is inappropriate, and observation without planned testing is unsafe.

Reference: Paracetamol 500 mg Tablets, Summary of Product Characteristics, section 4.9 Overdose, revised 22 January 2025. https://www.medicines.org.uk/emc/product/13494/smpc