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Paracetamol Overdose NAC — RACP Adult Medicine MCQ

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EasyGastroenterologyParacetamol Overdose NACRACP Adult Medicine

A 20-year-old woman presents 4 hours after ingesting 15 g of paracetamol in a deliberate self-harm attempt. She is asymptomatic. Paracetamol level at 4 hours is 200 mg/L (above treatment line on modified Rumack-Matthew nomogram). ALT 25 U/L, INR 1.0, creatinine 70. What is the most appropriate management?

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Correct answer: D — Commence IV N-acetylcysteine (NAC) protocol

Paracetamol level above the treatment line at 4 hours post-ingestion = commence NAC. Australian modified 2-bag NAC protocol (20-hour): 200 mg/kg in 500 mL 5% dextrose over 4 hours, then 100 mg/kg in 1 L over 16 hours. NAC is nearly 100% effective at preventing hepatotoxicity if started within 8 hours. Activated charcoal if presenting within 2 hours of ingestion. Assess for psychiatric review and safety.

Reference: Austin Health Toxicology 2024; eTG – 2024 – Paracetamol