A 59-year-old male (height: 5'8''; weight: 160 lbs) presented to the emergency department with the chief complaints of nausea and emesis. Physical examination: Febrile (99.4F) Left upper abdominal tenderness with evidence of mild hepatomegaly and mild sclera icterus. History: Moderate alcohol intake (10-12 drinks/week for the past several years).
He stated that he had also recently been taking approximately 8 tablets of Extra-Strength 500 mg acetaminophen each, over the course of the day, every day, for the past 2 weeks for pain relief from a recent knee injury sustained during a fall. Laboratory analysis revealed markedly elevated serum ALT (535 IU/L) and AST (430 IU/L) levels (normal values: 4-51 IU/L and 15-45 IU/L, respectively), increased bilirubin (41 µmol/L; normal: < 17 µmol/L), a serum glucose level of 2.0 mmol/L (normal: 3.9-5.8 mmol/L), and a blood acetaminophen concentration…
