This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Environment & Nutritional Pathology, Subject name: Pathology
A 26-year-old woman with a 6-month history of depression accompanied by active suicidal ideation ingests 35 g of acetaminophen. She quickly experiences nausea and vomiting. Within 1 day, she becomes progressively obtunded. On physical examination, her temperature is 36.9deg C, pulse is 75/min, respirations are 15/min, and blood pressure is 100/65 mm Hg. She is treated with N-acetylcysteine. Depletion of which of the following is most likely to accentuate her organ damage? 
Select and explain. 
A. Glutathione (GSH), B. Amylase, C. Creatine kinase, D. Ketone bodies
A: Glutathione (GSH)
Answer: A: Glutathione (GSH) 
Explanation: Acetaminophen toxicity leads to hepatic necrosis, indicated by rising ALT and AST levels. If death is not immediate, hyperbilirubinemia also can be seen. N-Acetylcysteine augments glutathione by contributing a sulfhydryl group for binding to toxic metabolites. Elevated serum amylase is seen in pancreatitis. Elevated serum creatine kinase is seen with injury to skeletal and cardiac muscle. Ketonuria is a feature of absolute insulin deficiency in diabetes mellitus; it also is a feature of starvation. Hypokalemia can be a feature of renal diseases and glucocorticoid deficiency.