skip to main content

Paracetamol overdose with uncertain timing — SCE Acute Medicine MCQ

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

ModerateToxicology and OverdoseParacetamol overdose with uncertain timingSCE Acute Medicine

A 33-year-old man presents 18 hours after taking an uncertain quantity of paracetamol with alcohol. ALT is 84 IU/L, INR 1.2 and paracetamol concentration is detectable. He is nauseated but haemodynamically stable. The time of ingestion is unreliable because he slept for several hours. 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: B — Start intravenous acetylcysteine immediately and seek toxicology advice

When timing is uncertain and paracetamol is detectable, acetylcysteine should be started rather than relying on a nomogram. Activated charcoal is most useful early after ingestion and is not definitive at 18 hours. Near-normal ALT does not exclude evolving hepatotoxicity. The safe approach is to treat first and refine risk with serial INR, ALT, creatinine and toxicology input.

Reference: TOXBASE paracetamol poisoning, BNF