A 59-year-old male (height: 5’8”; weight: 160 lbs) presented to the emergency department with nausea and emesis

A 59-year-old male (height: 5’8”; weight: 160 lbs) presented to the emergency department with nausea and emesis. On examination the patient was slightly febrile (99.4F) and had left upper abdominal tenderness with evidence of mild hepatomegaly and mild sclera icterus. The patient admitted to a history of moderate alcohol intake (10-12 drinks/week for the past several years).1 He stated that he had also recently been taking approximately 8 tablets of Extra-Strength Tylenol (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 of 58 µg/mL. The patient was admitted to the hospital and administered an intravenous infusion that included glucose and N-acetylcysteine (NAC).

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