Hello,
This is a medical emergency. A 16-year-old who ingested approximately 12 g of paracetamol and now, 80 hours later, has right upper abdominal pain, nausea, fatigue, elevated liver enzymes and bilirubin, and confusion/drowsiness requires immediate hospital assessment.
Although the overdose occurred more than 3 days ago, treatment may still be beneficial, and the presence of confusion or drowsiness raises concern for significant liver injury or early liver failure. He needs urgent evaluation by a team experienced in managing paracetamol overdose.
He should be taken immediately to the nearest emergency department, where doctors are likely to perform:
Repeat liver function tests (AST, ALT, bilirubin)
INR/PT (blood clotting tests)
Kidney function tests and electrolytes
Blood glucose
Blood gas/lactate if indicated
Serum paracetamol level (although it may no longer be detectable, it can still be checked)
Assessment for the need for intravenous N-acetylcysteine (NAC), which may still be recommended even when presentation is delayed if there is evidence of liver injury.
Because this was an intentional overdose and he has a history of anxiety, he should also receive a mental health assessment once he is medically stable.
Prescription / Advice:
Go to the nearest Emergency Department immediately or call emergency medical services if he is drowsy or difficult to wake.
Do not give any more paracetamol or medications that may affect the liver unless specifically prescribed by the treating doctors.
Ensure he is accompanied by a responsible adult and bring details of:
The estimated amount of paracetamol taken (12 g)
The time of ingestion (approximately 80 hours ago)
All current medications, including the benzodiazepine
Do not delay medical care while waiting for symptoms to improve.
After stabilization, arrange ongoing follow-up with both a physician and a mental health professional to address the overdose and the underlying anxiety.
This situation requires urgent hospital treatment today.
Feel free to reach out again.
Regards, Dr. Nirav Jain Family Medicine Specialist
Hello
This is a medical emergency. A 12 g paracetamol overdose with abnormal liver tests, right upper abdominal pain, nausea, fatigue, and especially confusion or drowsiness raises concern for paracetamol-induced liver injury, which can worsen several days after the overdose.
He should be taken to the emergency department immediately, even though the ingestion was 80 hours ago. Late treatment with N-acetylcysteine can still improve outcomes, and he needs urgent assessment with repeat liver function tests, INR/clotting profile, kidney function, blood glucose, electrolytes, and monitoring for acute liver failure.
Because this appears to have been an intentional overdose and he has a history of anxiety, he should also receive an urgent mental health assessment once he is medically stable.
Do not give any more paracetamol or alcohol, and do not delay seeking care. If his confusion worsens, he becomes difficult to wake, has persistent vomiting, seizures, or develops yellowing of the skin or eyes, call emergency services immediately.
Take care Feel free to reach out again
But the lft were only slightly elevated
Even if LFT is only mildly elevated, this is still urgent.
A 12 g paracetamol overdose + symptoms (pain, nausea, fatigue, confusion/drowsiness) at 80 hours means he needs immediate hospital review today.
Key point: LFT can look mild early but liver injury can still worsen later. More important tests are INR/PT, glucose, kidney function, not just SGOT/SGPT.
➡️ Go to ER now for possible IV N-acetylcysteine (NAC) and monitoring.
Hello dear It is a medical emergency requiring immediate hospitalization Since the time period that lapsed is 80 hrs so anti dote N acetyl cysteine may be still effective There will be requirement of gastric lavage Get following tests done for toxicity level Sgot Sgot Inr Pt Aptt Regards
Urgent hospitalization is required.
Given that 80 hours have passed since the ingestion of 12 grams of paracetamol, and considering the elevated liver enzymes (SGPT, SGOT) and bilirubin, immediate medical attention is required. Paracetamol overdose can lead to severe liver damage, and the fact that these symptoms and lab findings are present is concerning for potential hepatic injury. Time is critical in these situations. Acetylcysteine, an antidote for paracetamol toxicity, is typically most effective if given within 8-10 hours after ingestion. However, it can still provide benefits later and might be administrated in hospital settings based on specific criteria and the patient’s condition. You should contact your healthcare provider or take the patient to the emergency room where a complete evaluation can be performed. There they can assess liver function more comprehensively, potentially provide IV fluids, further liver support medication if needed and manage any complications that might arise. Vomiting, nausea, and fatigue add to the symptomatic burden and suggest progressing hepatic impairment which cannot be managed at home. Other causes of symptoms, including anxiety or other drugs, need attention too, but the paracetamol exposure is most urgent. The patient’s medications may also require reassessment to ensure no interactions contribute to the current status. To sum up, do not delay in seeking emergency medical care as this situation could evolve rapidly with serious implications if not properly addressed.
