1 The reactive metabolite responsible for paracetamol-induced hepatotoxicity, postulated to be N -acetyl-p-benzoquinoneimine reacts with N-acetyl cysteine.
2 An adduct is formed by an SN2 mechanism and paracetamol is produced by a redox reaction.
3 The adduct produced is capable of further oxidation by N-acetyl-p-benzoquinoneimine.
4 Methionine does not react with the reactive metabolite to any great extent.
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