Which medication overdose is associated with liver damage, potential encephalopathy, hypoglycemia, and right subcostal pain?

• A. Aspirin
• B. Paracetamol
• C. Ibuprofen
• D. Morphine

Answer: (B)

Paracetamol overdose is a classic cause of severe liver injury that can progress to hepatic failure with hepatic encephalopathy, hypoglycemia, and right upper quadrant pain. The toxic effect comes from a metabolite, NAPQI, which is normally detoxified by glutathione. In overdose, glutathione stores are overwhelmed and NAPQI binds to liver proteins, causing centrilobular necrosis. This liver damage can impair gluconeogenesis and other metabolic functions, leading to hypoglycemia and encephalopathy as toxins accumulate. The liver inflammation and cell death produce the right subcostal (right upper quadrant) pain patients may feel.

In practice, this pattern is most strongly associated with paracetamol because it directly targets the liver and drives potential cerebral dysfunction through hepatic failure. Other drugs listed tend to produce different toxicity profiles: aspirin overdose causes salicylate toxicity with metabolic acidosis and hyperventilation; ibuprofen overdose can cause GI and kidney effects; morphine overdose produces CNS depression and respiratory depression.