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Paracetamol overdose — SCE Acute Medicine MCQ

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HardClinical pharmacology and poisoningParacetamol overdoseSCE Acute Medicine

A 41-year-old man is brought in after being found collapsed beside empty paracetamol packets. He is alert but nauseated and says the ingestion was about 9 hours ago, though he is uncertain. ALT is 86 IU/L, INR 1.3 and paracetamol concentration is pending from the laboratory. He weighs 74 kg and has no known chronic liver disease. What is the most appropriate next step in management?

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Correct answer: D — Start intravenous acetylcysteine while the result is pending

Presentation more than eight hours after a potentially toxic paracetamol ingestion is time-critical. When the history is uncertain and the concentration is pending, acetylcysteine should begin immediately rather than await laboratory confirmation. Treatment can be reviewed when the concentration, timing, liver tests and INR are clarified.

Reference: https://www.gov.uk/drug-safety-update/treating-paracetamol-overdose-with-intravenous-acetylcysteine-new-guidance