In a retrospective review from 1987 to 1989, we identified seven alcoholics who had severe acute hepatocellular injury soon after using acetaminophen for therapeutic purposes and who had no suicidal intent. All had markedly elevated serum transaminase values (aspartate aminotransferase greater than 4000 U/L) and prolonged prothrombin times. Three died. Use of acetaminophen by the alcoholic patient is potentially lethal.