Paracetamol/Acetaminophen (NSAID) overdose

haemorrhagic necrosis of centrilobular zones (Z3) around central vein (greater activity of drug metabolizing enzymes)

AAST ALT marked increase due to necrosis of hepatocytes

can be seen with isoniazid, carbon tetrachloride, nitrofurantoin

Culprits

• paracetamol
• herbal and complementary medicines
• antibiotics
• NSAIDs
• TB meds
• carbamazepine

Clinical presentation

• asymptomatic to fulminant hepatic failure