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Staggered paracetamol overdose — SCE Acute Medicine MCQ

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EasyClinical pharmacology and poisoningStaggered paracetamol overdoseSCE Acute Medicine

A 27-year-old woman presents 18 hours after taking repeated supratherapeutic paracetamol doses over 2 days for dental pain. She is unsure of the total dose; ALT is 146 U/L, INR is 1.4 and paracetamol concentration is detectable but below the standard nomogram treatment line. What is the most appropriate next step in management?

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Correct answer: E — Start intravenous acetylcysteine and discuss with the poisons service

The treatment nomogram applies to single timed ingestions, not staggered overdose, and detectable paracetamol with abnormal liver tests warrants acetylcysteine and poisons-service advice. Waiting for jaundice would miss the window for preventing liver injury. Staggered overdoses are higher risk because timing and peak concentration are unreliable.

Reference: TOXBASE paracetamol poisoning; BNF acetylcysteine