Abstract
A 25-year-old man presents to the emergency department with a toothache and is found to have been ingesting large quantities of acetaminophen. Although no acetaminophen is detectable in his blood, his serum alanine aminotransferase concentration is 750 IU per liter, and treatment with acetylcysteine is recommended. Acetylcysteine repletes glutathione stores in the liver. It helps to prevent hepatotoxicity in cases of acetaminophen overdose and also improves survival in patients with acetaminophen-induced hepatic failure.