Hepatic necrosis with jaundice may occur after ingesting massive doses of which medication?

Hepatic necrosis accompanied by jaundice is most commonly associated with acute liver failure, which can occur due to the ingestion of massive doses of acetaminophen. Acetaminophen, while safe at therapeutic doses, has a narrow therapeutic window, and an overdose can lead to the generation of toxic metabolites that overwhelm the liver's ability to process them. This toxicity is particularly impactful when the liver's protective mechanisms, such as glutathione stores, are depleted.

In cases of overdose, the liver cells can experience significant damage leading to necrosis and subsequent liver failure, resulting in symptoms such as jaundice. Jaundice occurs because the liver is unable to process and excrete bilirubin, a byproduct of the normal breakdown of red blood cells, leading to its accumulation in the bloodstream.

Though other medications listed can cause liver issues, they do not typically lead to hepatic necrosis and jaundice as commonly or as severely as acetaminophen when taken in large doses. Recognizing the specific risks associated with acetaminophen is critical for diagnosis and treatment in cases of suspected overdose.