A female, Lalita, aged 26 years takes 100 tablets of paracetamol. Treatment of choice is: DNB 09; PGI 09; UP 11; FMGE 11; NEET 13
**Core Concept**
Paracetamol (acetaminophen) overdose is a common cause of acute liver failure. The treatment involves a combination of supportive care and specific antidotes to mitigate liver damage.
**Why the Correct Answer is Right**
Lalita's ingestion of 100 tablets of paracetamol is considered a toxic dose, exceeding the recommended daily limit. The primary treatment for paracetamol overdose is **N-acetylcysteine (NAC)**, which works by replenishing glutathione stores in the liver and reducing the formation of toxic metabolites. NAC also has antioxidant properties, which help to neutralize free radicals and prevent liver damage.
**Why Each Wrong Option is Incorrect**
**Option A:** Activated charcoal is not effective in treating paracetamol overdose, as it cannot bind the drug once it has been absorbed into the bloodstream.
**Option B:** Gastric lavage is not recommended, as it may cause more harm than good and is unlikely to remove the ingested paracetamol.
**Option C:** Supportive care alone is not sufficient to treat paracetamol overdose, as it does not address the underlying liver damage caused by the toxic metabolites.
**Option D:** Methionine is not the treatment of choice for paracetamol overdose, although it may be used as an antidote in some cases.
**Clinical Pearl / High-Yield Fact**
In cases of suspected paracetamol overdose, it's essential to initiate treatment promptly, as the effectiveness of NAC decreases with time. The antidote should be administered within 8-10 hours of ingestion for optimal results.
**Correct Answer: A. N-acetylcysteine (NAC)**