The study of acetaminophen toxicity by Kuffner et al1 may underestimate the actual risk in alcoholic patients. Depletion of hepatic glutathione and induction of P450-CYP2E1 are the most important factors that predispose to acetaminophen toxicity. Fasting and malnutrition further decrease hepatic glutathione and contribute to acetaminophen toxicity.2 In contrast, acute ethanol exposure does not appear to be a predisposing factor to acetaminophen toxicity.
Soll AH, Sees KL. Is Acetaminophen Really Safe in Alcoholic Patients?. Arch Intern Med. 2002;162(10):1194. doi: