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Staggered paracetamol overdose — SCE Acute Medicine MCQ

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ModerateToxicology and OverdoseStaggered paracetamol overdoseSCE Acute Medicine

A 43-year-old man is assessed on the acute medical unit. He has taken repeated supratherapeutic paracetamol doses for back pain over 36 hours. The exact timing is unclear and ALT is mildly raised. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate next step in management?

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Correct answer: B — Start intravenous N-acetylcysteine promptly

Start intravenous N-acetylcysteine promptly is the best answer because staggered overdose cannot be safely assessed by the standard nomogram and usually warrants treatment when risk is present. Give broad-spectrum intravenous antibiotics within one hour is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: The nomogram applies to a single acute ingestion with a known time.

Reference: Toxbase; BNF