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Paracetamol Overdose — RACP Adult Medicine MCQ

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HardGastroenterologyParacetamol OverdoseRACP Adult Medicine

A 30-year-old presents six hours after a single immediate-release paracetamol ingestion. The timed concentration is above the Australian treatment line and ALT is normal. What is the specific treatment?

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Correct answer: E — Commence the standard two-bag IV acetylcysteine regimen now rather than waiting for liver injury

The best answer is “Commence the standard two-bag IV acetylcysteine regimen now rather than waiting for liver injury”. A timed concentration above the nomogram treatment line indicates acetylcysteine even when ALT and INR are initially normal. Early treatment prevents NAPQI-mediated liver injury; biochemical damage may not yet be visible at six hours. Activated charcoal may have a selected early role but does not replace antidote treatment, and naloxone has no effect on paracetamol metabolism.

Reference: NSW Agency for Clinical Innovation: Management of paracetamol overdose: https://aci.health.nsw.gov.au/networks/eci/clinical/tools/paracetamol