**Core Concept**
The management of acute paracetamol overdose involves the use of specific antidotes to prevent or mitigate liver damage caused by the toxic metabolite N-acetyl-p-benzoquinone imine (NAPQI).

**Why the Correct Answer is Right**
In the management of acute paracetamol overdose, the administration of **N-acetylcysteine (NAC)** is the mainstay of treatment. NAC serves as a precursor to glutathione, which conjugates with NAPQI, thereby reducing its toxic effects on the liver. NAC also has antioxidant properties, helping to mitigate the oxidative stress caused by NAPQI.

**Why Each Wrong Option is Incorrect**
* **Option A:** This option is incorrect because activated charcoal is not effective in treating acute paracetamol overdose, especially if given more than 1 hour after ingestion. Charcoal may even interfere with the absorption of NAC.
* **Option B:** This option is incorrect because **fomepizole** is an antidote for methanol and ethylene glycol poisoning, not paracetamol overdose.
* **Option C:** This option is incorrect because **deferoxamine** is an iron chelator used to treat iron poisoning, not paracetamol overdose.

**Clinical Pearl / High-Yield Fact**
In the management of acute paracetamol overdose, NAC should be administered within 8-10 hours of ingestion for optimal efficacy. This timeframe is crucial, as the effectiveness of NAC decreases with time.

**Correct Answer: A. N-acetylcysteine (NAC) administration is the mainstay of treatment for acute paracetamol overdose.**