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Paracetamol overdose — RACP Paediatrics MCQ

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ModerateEmergencyParacetamol overdoseRACP Paediatrics

A 15-year-old presents 6 hours after a deliberate paracetamol overdose (estimated 200 mg/kg). The 4-hour paracetamol level is above the treatment line on the modified Rumack-Matthew nomogram. ALT is 45 U/L. What is the most appropriate treatment?

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Correct answer: E — N-acetylcysteine (NAC)

N-acetylcysteine (NAC) is the specific antidote for paracetamol poisoning. It should be commenced when the 4-hour level is above the treatment line on the nomogram. NAC is most effective when given within 8 hours of ingestion but should still be administered beyond this time if indicated. The standard protocol is a 21-hour IV NAC infusion.

Reference: RCH Melbourne – 2023 – Poisoning CPG; Australian Therapeutic Guidelines – 2024 – Toxicology