**Question:** Which is useful to decrease mortality and renal failure in acute liver disease due to alcoholism -

A. Vitamin E
B. N-acetylcysteine
C. Thiazide diuretics
D. Calcium channel blockers

**Core Concept:** Acute liver disease due to alcoholism can lead to liver injury and dysfunction. Kidney involvement in such cases can manifest as acute kidney injury (AKI), which is associated with increased morbidity and mortality.

**Why the Correct Answer is Right:**

B. N-acetylcysteine (NAC) is a precursor to the essential amino acid cysteine and plays a role in maintaining the antioxidant defense system within the body. In acute liver disease, excessive production of reactive oxygen species can lead to oxidative stress and tissue damage, including the kidneys. NAC administration can help in scavenging these reactive oxygen species, thereby protecting the liver and kidneys.

**Why Each Wrong Option is Incorrect:**

A. Vitamin E (Alpha-tocopherol) is an antioxidant that helps in preventing lipid peroxidation. While it has some protective effects in alcohol-induced liver disease, its role in renal protection is less clear compared to NAC.

C. Thiazide diuretics primarily reduce salt and water reabsorption in the kidneys, which may worsen renal tubular acidosis often seen in acute liver disease due to alcoholism. Moreover, thiazide diuretics are not directly beneficial for liver protection.

D. Calcium channel blockers are primarily used to treat hypertension and angina, and their role in acute liver disease and renal protection is not well established.

**Clinical Pearl:**

In patients with acute liver disease due to alcoholism, NAC administration may improve outcomes by mitigating oxidative stress and renal dysfunction. However, it is essential to consider the potential risks and benefits in each patient case and consult a medical expert before administering any medication.