An adolescent ingested an unknown number of paracetamol tablets 4 hours ago and is asymptomatic. Serum paracetamol concentration plots well above the treatment line on the Rumack-Matthew nomogram. What is the appropriate management?

• A Reassure and discharge since she is asymptomatic
• B Start N-acetylcysteine immediately ✓
• C Give activated charcoal and observe for 24 hours without an antidote
• D Perform gastric lavage and repeat the level after 4 hours before deciding

Explanation

A level above the treatment line on the Rumack-Matthew nomogram indicates probable hepatotoxicity and mandates N-acetylcysteine, which replenishes glutathione and detoxifies NAPQI; it is most effective within 8 hours of ingestion. Early paracetamol poisoning is characteristically asymptomatic, so clinical wellness means nothing. Charcoal alone does not prevent hepatic injury once the level crosses the line.

Reference: Katzung's Basic and Clinical Pharmacology, 15th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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