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Paracetamol overdose at 10 hours — SCE Acute Medicine MCQ

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HardToxicology and OverdoseParacetamol overdose at 10 hoursSCE Acute Medicine

A 68 kg woman presents two hours after ingesting 70 g of paracetamol. She is confused with pH 7.12 and lactate 11 mmol/L despite resuscitation; the paracetamol concentration is 980 mg/L and liver tests are initially near normal. Intravenous acetylcysteine has started. What additional intervention should be discussed urgently with NPIS?

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Correct answer: D — Discuss intermittent haemodialysis while continuing acetylcysteine

Massive paracetamol poisoning can cause early coma and lactic acidosis from mitochondrial toxicity before hepatotoxicity appears. Very high concentration with persistent severe acidosis is an indication to discuss haemodialysis urgently with NPIS. Acetylcysteine must continue, usually at an increased rate during dialysis because it is dialysable.

Reference: https://www.extrip-workgroup.org/acetaminophen