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Paracetamol hepatotoxicity — FRCA Primary MCQ

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HardPharmacologyParacetamol hepatotoxicityFRCA Primary

A malnourished patient with chronic alcohol use takes repeated supratherapeutic paracetamol doses for dental pain and presents with rising ALT. Which biochemical process is most relevant?

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Correct answer: E — Glutathione depletion with NAPQI accumulation

Paracetamol toxicity occurs when glutathione stores are depleted and the reactive metabolite NAPQI accumulates, causing hepatocellular injury. Cyclo-oxygenase-1 irreversible blockade is aspirin-like, not paracetamol-like. Renal prostaglandin inhibition is more characteristic of NSAIDs. Malnutrition and chronic alcohol use increase vulnerability, so repeated supratherapeutic dosing can be dangerous.

Reference: Peck, Hill & Williams Pharmacology for Anaesthesia and Intensive Care; BNF