This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Liver & Biliary Tract, Subject name: Pathology
[{'content': 'A 66-year-old woman with a history of chronic alcohol abuse has had headaches and nausea for the past 4 days. She has become increasingly obtunded. On physical examination, she has right upper quadrant tenderness, tachycardia, tachypnea, and hypotension. Laboratory studies show serum AST of 475 U/L, ALT of 509 U/L, alkaline phosphatase of 23 U/L, total bilirubin of 0.9 mg/dL, albumin of 3.8 g/dL, and total protein of 6.1 g/dL. She is treated with N-acetylcysteine. Which of the following drugs has she most likely ingested in excess? \nSelect and explain. \nA. Acetaminophen, B. Aspirin, C. Ibuprofen, D. Meperidine', 'role': 'user'}, {'content': 'Answer: A \nExplanation: In the setting of chronic liver disease, the ingestion of acetaminophen is more likely to produce hepatotoxicity because detoxification by conjugation is exceeded. This leads to metabolism by cytochrome P-450 to the toxic metabolite N-acetyl-p-benzoquinone imine (NAPQI), which accumulates beyond the capacity of glutathione. The N-acetylcysteine increases available glutathione. Aspirin ingestion is a cause for Reye syndrome in children. Ibuprofen, which is a nonsteroidal anti-inflammatory drug (NSAID), meperidine, and oxycodone do not have significant hepatotoxicity.', 'role': 'assistant'}]