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17th May 2025
A 65-year-old patient who was admitted following a paracetamol overdose became jaundiced, ataxic, tremulous on extending his upper limbs and became more agitated and confused.
A 65-year-old patient who was admitted following a paracetamol overdose became jaundiced, ataxic, tremulous on extending his upper limbs and became more agitated and confused. He has a history of alcohol excess and took an overdose of 300 mg/kg over an unknown period of time. He had received 2 bags of N-acetyl cysteine (NAC) since admission.
Investigations:
| On admission | After 2 bags of NAC | |
|---|---|---|
| Haemoglobin | 151 g/L | 142 g/L (130–180) |
| White cell count | 4.5 × 109/L | 5.8 × 109/L (4.0–11.0) |
| Platelet count | 670 × 109/L | 682 × 109/L (150–400) |
| INR | 1.1 | 1.2 (<1.4) |
| Serum total bilirubin | 79 µmol/L | 63 µmol/L (1–22) |
| Serum alanine aminotransferase | 76 U/L | 60 U/L (5–35) |
| Serum aspartate aminotransferase | 84 U/L | 75 U/L (1–31) |
| Paracetamol level | 550 mg/L | 200 mg/L |
What treatment should be given?
Select the SINGLE most appropriate option from the list below. Select ONE option only.
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