What is a major safety concern with acetaminophen overdose?

• A. Hepatotoxicity
• B. Renal failure
• C. Hypertension
• D. Respiratory depression

Answer: (A)

Liver injury from an acetaminophen overdose is the major safety concern. When taken in large amounts, the body's usual pathways to metabolize acetaminophen become overwhelmed, and more of the drug is converted into a toxic metabolite that can damage liver cells. Normally this toxin is neutralized by glutathione, but in overdose stores are quickly depleted. Without enough glutathione, the toxin binds to cellular proteins in hepatocytes, causing oxidative damage and cell death, especially in the central part of the liver. This injury leads to rising liver enzymes, jaundice, and can progress to acute liver failure if not treated. The antidote, N-acetylcysteine, helps by replenishing glutathione and reducing toxicity, and it’s most effective when given early.

Renal injury can occur but is less common as the primary danger, while hypertension and respiratory depression are not typical major concerns with acetaminophen overdose.