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Acute liver failure — RACP Paediatrics MCQ

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HardGastroenterologyAcute liver failureRACP Paediatrics

A 4-year-old presents 20 hours after possible paracetamol ingestion with vomiting, drowsiness and right upper quadrant tenderness. ALT is markedly elevated, INR is 2.3 and paracetamol level is detectable. What is the most appropriate management?

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Correct answer: D — Start intravenous acetylcysteine and contact a liver transplant centre

Paracetamol-related liver injury with coagulopathy requires intravenous acetylcysteine and urgent specialist liver advice. The nomogram is less helpful in late or uncertain presentations with established liver injury. INR elevation and encephalopathy features are red flags for acute liver failure.

Reference: Poisons Information Centre; Therapeutic Guidelines (eTG)