Paracetamol (acetaminophen) poisoning is a prevalent medical emergency worldwide and a leading cause of acute liver failure. Overdose can result from a single acute ingestion, repeated supratherapeutic doses, or chronic exposure. The risk of significant morbidity and mortality increases if not managed promptly and appropriately. Early recognition, risk stratification, and timely intervention are crucial. The cornerstone of management includes thorough patient assessment, application of the Rumack-Matthew nomogram (with revisions for high-risk populations), and administration of acetylcysteine. Recent advancements have led to updated guidelines and protocols, emphasizing considerations for special populations, modified-release formulations, and resource-limited settings [1, 2]. [Ref: Algorithm 97.1].