Vicki, a 57-year-old woman, has suffered from

Vicki, a 57-year-old woman, has suffered from osteoarthritis for the last 2 years. Since Vicki has a history of aspirin sensitivity (which manifests as bronchospasm), NSAIDs are contraindicated. She initially used paracetamol for analgesia, but due to worsening pain Vicki’s general practitioner prescribed panadeine forte, two tablets 8-hourly. Vicki obtains no additional benefit from the panadeine forte, and in frustration she takes a ‘couple of handfuls’ (later estimated as about 30 tablets) of panadeine forte tablets. After 2 hours Vicki felt nauseous and told her husband what she had done. Vicki’s husband took her to the emergency department of their local hospital. Vicki was treated with intravenous N-acetylcysteine, according to the standard protocol. What is the mechanism of action of N-acetylcysteine? Why is glutathione not used as an antidote? Question Three Vicki’s husband later admitted to the treating doctor that she had been drinking alcohol excessively for some months. Can excessive ethanol intake affect the severity of paracetamol hepatotoxicity?

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