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Acute liver failure from paracetamol — SCE Acute Medicine MCQ

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ModerateAcute Gastrointestinal PresentationsAcute liver failure from paracetamolSCE Acute Medicine

A 67-year-old woman presents with acute abdominal pain, bleeding, jaundice or vomiting. Relevant history includes gastrointestinal or hepatobiliary risk factors. On assessment, abdominal examination and physiology suggest significant acute illness. Investigations show encephalopathy, INR 4.8 and ALT 5200 after paracetamol excess. What is the most appropriate next step in management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Start acetylcysteine and refer urgently to a liver transplant centre

The key discriminator is that encephalopathy, INR 4.8 and ALT 5200 after paracetamol excess, which makes Start acetylcysteine and refer urgently to a liver transplant centre the single best answer. Provide supportive care and close monitoring is less appropriate because it does not address the dominant acute risk in the vignette; Give analgesia and antiemetic therapy would fit a different presentation or later stage of care. Give controlled oxygen and senior review and Start broad-spectrum intravenous antibiotics are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: BSG acute liver failure guidance; TOXBASE