A patient has been admitted after overdosing on acetaminophen. The nurse plans to monitor this patient for development of which complication related to the overdose?

A. Metabolic alkalosis: Acetaminophen overdose does not typically cause alkalosis; the primary toxicity involves hepatic injury rather than disturbances in acid–base balance. Other conditions such as vomiting or diuretic use are more commonly associated with alkalosis, not acetaminophen toxicity. B. Kidney stones: Kidney stones are not linked to acetaminophen overdose and generally occur due to dietary factors, dehydration, or metabolic imbalances. Acetaminophen toxicity affects the liver far more significantly than the renal system in most cases. C. Decreased urinary output: While severe liver injury can eventually impact renal perfusion, decreased urine output is not the primary expected complication. It is a secondary effect that may occur later in fulminant liver failure but is not the main concern initially. D. Acute hepatic necrosis: Acetaminophen overdose causes direct liver-cell injury due to toxic metabolite accumulation, leading to hepatic necrosis within 24–72 hours. Monitoring liver enzymes, coagulation status, and mental status is crucial to detect impending liver failure.