شابة عمرها ١٩ سنة وصلت بعد ٥ ساعات من بلع ٣٠ حبة باراسيتامول بعد مشكلة عائلية. الآن تشعر بغثيان خفيف فقط. العلامات الحيوية طبيعية. أهلها يقولون إن حالتها جيدة ويريدون الخروج. ما الرد المناسب؟

A 19-year-old arrives 5 hours after swallowing 30 paracetamol tablets after a family conflict. She now has only mild nausea and normal vitals. Her family says she is fine and wants to leave. What is the best response?

1. Paracetamol is safe even in large doses, so fluids are enough
2. Liver injury appears after 1–3 days; she needs a level and acetylcysteine
3. She is stable now, so a clinic follow-up in a week is enough
4. She needs gastric lavage now and may leave if there is no vomiting within the hour

Answer: B) Liver injury appears after 1–3 days; she needs a level and acetylcysteine. Paracetamol poisoning looks mild early, with liver injury appearing at 24–72 hours. A level is taken at 4 hours or later and acetylcysteine given as indicated. Suicide risk is assessed and safety ensured.