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Paracetamol-induced acute liver failure — SCE Acute Medicine MCQ

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HardAcute GI PresentationsParacetamol-induced acute liver failureSCE Acute Medicine

A 29-year-old woman presents 36 hours after a large paracetamol overdose. She is confused, INR is 6.8, ALT is 5,400 IU/L, creatinine is 212 micromol/L and arterial pH is 7.28 after initial resuscitation. Acetylcysteine has been started. What is the most appropriate next step in management?

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Correct answer: C — Urgent discussion with a liver transplant centre

Encephalopathy, severe coagulopathy, renal injury and acidosis after paracetamol overdose indicate acute liver failure and potential transplant criteria. NAC should continue based on clinical and biochemical recovery rather than paracetamol detectability alone. Bilirubin may be modest early in hyperacute liver failure, so a normal value is falsely reassuring. The pearl is to refer early because transfer can become unsafe as cerebral oedema and shock develop.

Reference: British Society of Gastroenterology acute liver failure guidance; TOXBASE