Which one of the following diseases or conditions predisposes a patient to acetaminophen toxicity?: (A) Type 1 diabetes, (B) Type 2 diabetes, (C) Alcoholism, (D) Pernicious anemia
Answer is C. The enzyme that produces the toxic NAPQI, CYP2E1, is induced by alcohol. Diabetes (either type 1 or type 2) will not lead to an induction of CYP2E1, nor will pernicious anemia (intrinsic factor deficiency) or obesity (in the absence of alcoholism). Chronic alcoholics have a reduced tolerance for acetaminophen because of the induction of the MEOS, which results in increased levels of CYPE21.