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Paracetamol in liver disease — GPhC CRA MCQ

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HardRenal and Hepatic ImpairmentParacetamol in liver diseaseGPhC CRA

A 48 kg adult with alcohol-related liver disease has taken paracetamol 1 g at 06:00, 10:00, 14:00, 18:00, 22:00 and 02:00 on each of the last two days. Which calculation and action are correct?

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

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Correct answer: C — 6 g/day (125 mg/kg/day); arrange urgent assessment now

Six 1 g doses give 6 g in 24 hours; 6,000 mg divided by 48 kg is 125 mg/kg/day. This exceeds the licensed adult maximum of 4 g (eight 500 mg tablets) in 24 hours. Alcohol-related liver disease adds concern, and repeated excessive dosing cannot be made safe by only changing future doses. The patient needs urgent assessment even if currently well; co-codamol would add further paracetamol.

Reference: Paracetamol SmPC: https://www.medicines.org.uk/emc/product/10241/smpc; NHS paracetamol dosing: https://www.nhs.uk/medicines/paracetamol-for-adults/how-and-when-to-take-paracetamol-for-adults/