A 37-year-old alcoholic presented to hospital with metabolic acidosis, hypoglycemia, hypoprothrombinemia, and markedly elevated SGOT level. Despite the absence of volunteered information, acetaminophen hepatotoxicity was considered the probable cause, and this diagnosis was eventually supported. This combination of findings appears to be highly suggestive of well-established acetaminophen hepatotoxicity and implies that the drug-induced lesion selectively impairs certain hepatocellular functions early in the progression of the injury.