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Paracetamol-induced acute liver failure — ESEGH MCQ

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HardHepatologyParacetamol-induced acute liver failureESEGH

A 27-year-old woman presents 18 hours after taking a large paracetamol overdose. She is vomiting and confused. Blood tests show pH 7.24, lactate 5.8 mmol/L, INR 5.6, creatinine 214 micromol/L and ALT 4,800 IU/L. What is the most important next step?

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Correct answer: C — Discuss immediately with a specialist liver transplant centre

Acidosis, high lactate, encephalopathy, renal impairment and marked coagulopathy after paracetamol overdose indicate acute liver failure and require urgent transplant-centre discussion alongside N-acetylcysteine and intensive care. Waiting for a late paracetamol level is unsafe. Autoimmune hepatitis is not the immediate working diagnosis. The pearl is that transplant referral is a time-critical resuscitation intervention, not an administrative step.

Reference: BSG Acute Liver Failure Guidance; TOXBASE/NICE Medicines Guidance