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Staggered paracetamol overdose — SCE Acute Medicine MCQ

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ModerateToxicology and OverdoseStaggered paracetamol overdoseSCE Acute Medicine

A 71-year-old woman presents with collapse, confusion or vomiting after a possible exposure. Relevant history includes medication, recreational or environmental exposure. On assessment, toxidrome features and physiological instability are present. Investigations show repeated supratherapeutic ingestion with raised ALT and INR. What is the most appropriate next step in management?

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Correct answer: E — Start intravenous acetylcysteine irrespective of the acute nomogram

The key discriminator is that repeated supratherapeutic ingestion with raised ALT and INR, which makes Start intravenous acetylcysteine irrespective of the acute nomogram the single best answer. Give targeted antidote or reversal therapy is less appropriate because it does not address the dominant acute risk in the vignette; Optimise chronic medication and discharge would fit a different presentation or later stage of care. Arrange routine outpatient follow-up and Provide supportive care and close monitoring 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: TOXBASE; BNF acetylcysteine