Sat27November0556PM 31

A 25-year-old male with a history of alcohol dependence and chronic hepatitis is admitted with reduced consciousness. He has been found at home by a friend who said he has recently been depressed and threatening suicide.

On examination, he is tachycardic and hypotensive with a blood pressure of 90/60 mmHg. His Glasgow coma scale is 13/15. There is no jaundice or hepatomegaly evident.

His plasma-paracetamol concentration is detected to be 70 mg/litre.

What is the most appropriate intervention for this patient?

(Please select 1 option)

Supportive therapy with IV 5% glucose

Supportive management with IV saline Incorrect answer selected

IV acetylcysteine This is the correct answer

Gastric lavage

Oral methionine

Explanation

This patient is likely to have taken an overdose of paracetamol, the timing of which is unclear from the history; therefore the level of 70 mg/litre is difficult to interpret on the BNF graph for paracetamol overdose.

If there is doubt about the timing of the overdose or the need for treatment, then the patient should be treated with N-acetylcysteine

Oral methionine is used in remote areas if acetylcysteine cannot be given promptly.

There is little evidence that gastric lavage is of benefit in patients who have overdosed solely on paracetamol.

Answer Statistics

1

1%

2

8%

3

91%

4

1%

Times answered: 288