skip to main content

Acute liver failure after paracetamol overdose — SCE Acute Medicine MCQ

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

ModerateGastroenterology and hepatologyAcute liver failure after paracetamol overdoseSCE Acute Medicine

A 28-year-old woman presents three days after a staggered paracetamol overdose. She is drowsy but rousable, with asterixis. ALT is 4,800 IU/L, INR 7.1, creatinine 264 micromol/L and arterial pH is 7.24 after fluid resuscitation. Paracetamol is undetectable and she has already received acetylcysteine. 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: D — Discuss urgently with a specialist liver transplant centre and continue supportive care

This is acute liver failure with encephalopathy, severe coagulopathy, acidosis and renal impairment after paracetamol toxicity. The priority is urgent discussion with a specialist liver/transplant centre while continuing acetylcysteine and organ-supportive care. An undetectable paracetamol concentration does not exclude established toxicity, and vitamin K or lactulose alone does not address transplant-level risk.

Reference: BSG Acute Liver Failure Guidance; TOXBASE; BNF Acetylcysteine