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Hepatorenal Syndrome Paracetamol — ESENeph MCQ

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ModerateAcute Kidney InjuryHepatorenal Syndrome ParacetamolESENeph

A 28-year-old man presents with a respiratory alkalosis (pH 7.52, pCO2 2.8 kPa) and metabolic acidosis (bicarbonate 12 mmol/L). He has AKI (creatinine 580 umol/L), jaundice (bilirubin 120 umol/L), and coagulopathy (INR 4.2). He took a paracetamol overdose 3 days ago. What is the most important consideration for his AKI management?

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Correct answer: A — Urgent referral to a liver transplant centre – King's College Criteria assessment

This patient has paracetamol-induced acute liver failure with AKI (hepatorenal syndrome/acute tubular necrosis). The combination of metabolic acidosis, coagulopathy, renal failure, and encephalopathy suggests he may meet King's College Criteria for emergency liver transplantation. While standard AKI management (avoiding nephrotoxins, RRT if needed) is important, the key action is urgent referral to a liver transplant centre for assessment. NAC should be continued but will not reverse established hepatorenal failure.

Reference: NICE CG16 2016 – Paracetamol Overdose; King's College Criteria