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Paracetamol overdose liver disease — GPhC CRA MCQ

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HardRenal and Hepatic ImpairmentParacetamol overdose liver diseaseGPhC CRA

A 45-year-old man with alcohol-related liver disease asks for paracetamol after taking eight 500 mg tablets over four hours for dental pain. He has nausea and right upper quadrant discomfort. What is the most appropriate action?

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Correct answer: B — Refer immediately for emergency assessment because staggered overdose risk is increased

Repeated supratherapeutic or staggered paracetamol ingestion can be dangerous, particularly with liver disease or alcohol dependence. Symptoms may be non-specific and should not reassure the pharmacist. Urgent assessment is required for paracetamol concentration interpretation and possible antidote treatment. OTC substitution with NSAIDs could also be unsafe in liver disease.

Reference: BNF; NICE CKS