Which of the following NSAIDs can cause hepatic necrosis if used in overdose?
## **Core Concept**
The question tests knowledge of the adverse effects of various Nonsteroidal Anti-Inflammatory Drugs (NSAIDs), specifically their potential to cause hepatic necrosis in overdose. NSAIDs are known for their analgesic, anti-inflammatory, and antipyretic properties, but they can also have significant side effects, particularly when taken in excessive amounts.
## **Why the Correct Answer is Right**
The correct answer, , is known for its association with hepatotoxicity, particularly in overdose. Acetaminophen (also known as paracetamol) is metabolized in the liver, and in overdose, the glucuronic acid and sulfate conjugation pathways become saturated. This leads to an increased formation of N-acetyl-p-benzoquinone imine (NAPQI), a toxic metabolite that depletes glutathione stores and causes liver cell necrosis. This is a well-documented risk of acetaminophen overdose.
## **Why Each Wrong Option is Incorrect**
- **Option A:** is not commonly associated with hepatic necrosis in the same way as acetaminophen. While all NSAIDs can have gastrointestinal and renal side effects, they are not typically known for causing hepatic necrosis in overdose to the extent that acetaminophen does.
- **Option B:** is another NSAID that can have serious side effects, including renal impairment and gastrointestinal bleeding, but it is not specifically known for causing hepatic necrosis in overdose.
- **Option D:** , like other NSAIDs, can cause gastrointestinal irritation, renal dysfunction, and other side effects but is not uniquely associated with hepatic necrosis in the context of overdose.
## **Clinical Pearl / High-Yield Fact**
A critical clinical pearl is that **acetaminophen-induced hepatic necrosis can be prevented or mitigated with N-acetylcysteine (NAC)**, which acts by replenishing glutathione stores and directly binding to NAPQI. Early administration of NAC is crucial in the management of acetaminophen overdose and can significantly reduce the risk of liver damage.
## **Correct Answer:** . Acetaminophen