A 24-year-old woman presents to the Emergency Department 6 hours after deliberately ingesting 32 tablets of paracetamol 500mg (total 16g). She weighs 65kg.
She reports no vomiting and has no significant past medical history. She does not take any regular medications and denies alcohol excess.
Observations:
- BP 118/76 mmHg, HR 82 bpm, RR 16/min, SpO₂ 98% on room air, Temp 36.8°C
Bloods:
- ALT 28 U/L, INR 1.0, Creatinine 68 µmol/L
- Serum paracetamol level at 6 hours post-ingestion: 140 mg/L
According to UK guidelines, what is the most appropriate immediate management?
A
Repeat paracetamol level in 2 hours before treating
B
Activated charcoal 50g orally immediately
C
Commence acetylcysteine using the 2021 two-bag regimen
D
Observe and discharge if asymptomatic
E
Await 8-hour level before starting acetylcysteine