MBBS OSCE · Emergency / Toxicology

Paracetamol overdose — risk assessment and NAC OSCE

OSCE on toxic dose, nomogram, IV NAC regimen, anaphylactoid reaction, psych risk and King's College criteria awareness.

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Candidate instructions[1]

Assess the overdose, start NAC, manage a mild infusion reaction, and arrange psychosocial assessment.[1]

Candidate tasks[1]

  1. Confirm time, dose (mg/kg), co-ingestants, intent.
  2. Interpret need for NAC from timed level.
  3. Prescribe three-bag IV NAC with doses.
  4. Manage anaphylactoid reaction without abandoning NAC.
  5. Refer for mental-health/risk assessment before discharge planning.[1]

Examiner checklist[1]

  • Toxic dose concept (≥150 mg/kg — 92.6 percent sensitive against the treatment line)[1]
  • NAC indicated; nearly 100% protective if <8 h
  • Correct loading and maintenance concept
  • Anaphylactoid ≠ true allergy; slow/restart after antihistamine
  • LFTs/INR monitoring plan
  • Psychosocial assessment mandatory

Model standard[1]

Start NAC promptly for above-line levels; continue through minor anaphylactoid reactions after treatment (8.2 percent of courses; mostly cutaneous; do not abandon);[2] monitor for hepatotoxicity; never discharge without psychiatric risk assessment.

Common errors[1]

  • Waiting for ALT rise before NAC
  • Stopping NAC permanently after flush/urticaria
  • No psych review
References2Show
  1. [1]Smilkstein MJ, Knapp GL, Kulig KW, Rumack BH. Efficacy of oral N-acetylcysteine in the treatment of acetaminophen overdose. N Engl J Med, 1988.PMID 3059186
  2. [2]Yarema M, Chopra P, Sivilotti MLA, et al. Anaphylactoid Reactions to Intravenous N-Acetylcysteine during Treatment for Acetaminophen Poisoning. J Med Toxicol, 2018.PMID 29423816
Paracetamol overdose — risk assessment and NAC OSCE · MBBS OSCE · NeetVellum