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Paracetamol in severe liver disease — GPhC CRA MCQ

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HardRenal and Hepatic ImpairmentParacetamol in severe liver diseaseGPhC CRA

A 55-year-old man with decompensated cirrhosis asks to buy paracetamol for abdominal pain. He has jaundice, increasing abdominal swelling and has taken 1g four times daily for 4 days. He also drank alcohol yesterday after a relapse. What is the most appropriate action?

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Correct answer: E — Refer for urgent medical assessment and avoid further unsupervised paracetamol

Jaundice, ascites and new abdominal pain in cirrhosis require urgent assessment. Although paracetamol may sometimes be used cautiously in liver disease under advice, unsupervised continued maximum dosing with recent alcohol use is unsafe. NSAIDs can be hazardous in cirrhosis due to renal and bleeding risks. Co-codamol adds opioid-related risks and may mask serious symptoms.

Reference: BNF Paracetamol; NICE CKS Cirrhosis