A patient with severe anorexia nervosa, who ingested 15 gm. of acetaminophen, was treated with oral N-acetylcysteine. Contrary to suggestions in the literature that malnutrition increases the susceptibility of patients to the hepatotoxic effects of acetaminophen this patient survived without evidence of liver damage. Changes in the metabolism of acetaminophen secondary to poor nutrition may explain the benign course in this and similar patients.