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Early Paracetamol Activated Charcoal — RACP Adult Medicine MCQ

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EasyGastroenterologyEarly Paracetamol Activated CharcoalRACP Adult Medicine

A 30-year-old woman presents 1 hour after ingesting 12 g of paracetamol. She is alert and asymptomatic. Her 4-hour paracetamol level will not be available for 3 hours. She is anxious and wants to go home. What is the most appropriate immediate management?

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Correct answer: A — Activated charcoal only

Presentation within 2 hours of paracetamol ingestion → activated charcoal 50 g (reduces absorption by ~50% if given within 1 hour, ~30% at 2 hours). Then wait for 4-hour paracetamol level to plot on the nomogram and decide on NAC. Do NOT discharge before the 4-hour level is available. If ingestion >12 g (or >75 mg/kg) and presenting early, NAC should be commenced empirically if there will be delay in obtaining levels.

Reference: Austin Health Toxicology 2024; eTG 2024 Paracetamol