skip to main content

Staggered paracetamol overdose — SCE Acute Medicine MCQ

Instant feedback + full explanation. One question, done properly.

HardToxicology and OverdoseStaggered paracetamol overdoseSCE Acute Medicine

A 34-year-old woman presents after taking repeated supratherapeutic doses of paracetamol for dental pain over 30 hours. The total reported dose is uncertain. She has nausea, right upper quadrant tenderness, ALT 286 IU/L, INR 1.4 and a detectable paracetamol concentration. Time of first ingestion is unclear. What is the most appropriate next step in management?

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

Reveal the answer and explanation

Correct answer: C — Start intravenous acetylcysteine immediately and discuss with NPIS

Staggered or uncertain-time paracetamol overdose cannot be managed safely with the single acute ingestion nomogram. Detectable paracetamol with evolving liver injury warrants immediate acetylcysteine and poisons advice. Activated charcoal has a limited early role and is not definitive here. The pearl is that treatment decisions depend on timing pattern as much as the plasma concentration.

Reference: TOXBASE; MHRA NAC safety update; BNF