History:

A 32-year-old woman presents to the emergency department complaining of nausea, vomiting, and abdominal pain, which started about 24 hours ago. She mentions that she took an overdose of paracetamol (acetaminophen) the previous evening after feeling stressed due to personal issues. She is unsure of the exact amount but reports taking "several" extra-strength paracetamol tablets. She also admits to drinking alcohol that night.

The patient has no significant past medical history, is not on any regular medications, and denies any history of liver disease or other chronic illnesses.

Examination:

On physical examination, she appears mildly distressed but is alert and oriented. Her vital signs are stable, with a blood pressure of 125/80 mmHg, heart rate of 88 beats per minute, and temperature of 37.2°C. She has mild tenderness in the upper right abdomen, and there is no obvious jaundice. No signs of acute liver failure, such as encephalopathy or bleeding, are noted.

Laboratory Results:

Paracetamol level: 200 μg/mL (at 24 hours post-ingestion)

Liver function tests:

ALT: 500 U/L (elevated)

AST: 450 U/L (elevated)

Bilirubin: 1.2 mg/dL (normal)

Coagulation profile: Normal

Renal function: Normal

Diagnosis:

The patient is diagnosed with acute paracetamol poisoning, which is suspected to have led to potential liver injury.

Management:

The patient is started on intravenous N-acetylcysteine (NAC) to mitigate the risk of hepatotoxicity and potential acute liver failure. She is monitored closely for worsening liver function and complications. A liver transplant team is informed as a precautionary measure in case of severe liver damage or failure.