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Acute paracetamol overdose — SCE Acute Medicine MCQ

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ModerateToxicology and OverdoseAcute paracetamol overdoseSCE Acute Medicine

A 76-year-old man 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 large ingestion at three hours with initially normal ALT. What is the most appropriate next step in management?

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Correct answer: A — Start acetylcysteine now if treatment-line risk is likely or timing is uncertain

The key discriminator is that large ingestion at three hours with initially normal ALT, which makes Start acetylcysteine now if treatment-line risk is likely or timing is uncertain the single best answer. Start anticoagulation after assessing bleeding risk is less appropriate because it does not address the dominant acute risk in the vignette; Start broad-spectrum intravenous antibiotics would fit a different presentation or later stage of care. Arrange routine outpatient follow-up and Give targeted antidote or reversal therapy 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