What is a potentially serious outcome of acetaminophen overdose?

• A. Liver failure
• B. Kidney stones
• C. Hepatic steatosis
• D. Pulmonary fibrosis

Answer: (A)

Overdose on acetaminophen can cause severe liver injury because a toxic metabolite builds up when normal detox pathways are overwhelmed. Normally, acetaminophen is safely processed, but in large amounts a portion is converted to NAPQI. When glutathione stores are depleted, NAPQI damages hepatocytes, leading to centrilobular necrosis and potentially liver failure. This is the primary life-threatening outcome you worry about after an overdose, and treatment with N-acetylcysteine works by replenishing glutathione to detoxify NAPQI.

Other options don’t fit as the classic serious consequence: kidney stones are unrelated to the acute toxic mechanism, hepatic steatosis is a chronic fatty liver change not an immediate overdose effect, and pulmonary fibrosis is not associated with acetaminophen toxicity.