Paracetamol overdose (70/1700)

An 18yo female just received her A-Level results and she didn’t get into the university of her
choice. She was brought into the ED after ingestion of 24 paracetamol tablets. Exam: confused
and tired. Initial management has been done. Inv after 24h: normal CBC, ABG = pH7.1, PT=17s,
Bilirubin=4umol/L, creatinine=83umol/L. What is the next step in management?

a. Observation for another 24h
b. Refer to psychologist
c. Give N-Acetylcysteine
d. Discharge with psychiatry referral
e. Liver transplantation



























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answer: E

King's college criteria for liver transplant

pH <7.30 alone

OR

arterial lactate >3.0 mmol/L

OR

combined grade III or IV hepatic encephalopathy

AND

a PT time > 100s (inr>6.5)

AND

creatinine > 3.4 mg/dL(300umol/L)